Provider Demographics
NPI:1326889148
Name:DAVIS, CHANDLER MACKENZIE (FNP-C)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:MACKENZIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CHANDLER
Other - Middle Name:MACKENZIE
Other - Last Name:KNICKERBOCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2877 E COGGINS RD
Mailing Address - Street 2:
Mailing Address - City:PINCONNING
Mailing Address - State:MI
Mailing Address - Zip Code:48650-9750
Mailing Address - Country:US
Mailing Address - Phone:810-347-2782
Mailing Address - Fax:
Practice Address - Street 1:1064 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9421
Practice Address - Country:US
Practice Address - Phone:989-654-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704339158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily