Provider Demographics
NPI:1427789064
Name:DAVIS, ALISA PORTER (NP)
Entity type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:PORTER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-475-3500
Mailing Address - Fax:801-475-3494
Practice Address - Street 1:1560 RENAISSANCE TOWNE DR STE 210
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7666
Practice Address - Country:US
Practice Address - Phone:801-397-6200
Practice Address - Fax:801-397-6201
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT6991383-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner