Provider Demographics
NPI:1487109146
Name:DAVENPORT, ANNETTE PATRICIA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:PATRICIA
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:ANNETTE
Other - Middle Name:PATRICIA
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:5132 N ELSTON AVE
Mailing Address - Street 2:KAREFIRST MISSOURI PC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2529
Mailing Address - Country:US
Mailing Address - Phone:847-235-6130
Mailing Address - Fax:847-235-6135
Practice Address - Street 1:1551 WALL STREET, LOGISTICS HEALTH INC
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303
Practice Address - Country:US
Practice Address - Phone:636-669-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016030306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily