Provider Demographics
NPI:1316904709
Name:DAVIS, ALICE E (PHD, NP)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50839 HANFORD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4618
Mailing Address - Country:US
Mailing Address - Phone:734-416-7060
Mailing Address - Fax:
Practice Address - Street 1:1059 KILAUEA AVE STE A
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4290
Practice Address - Country:US
Practice Address - Phone:734-712-5606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704200537363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care