Provider Demographics
NPI:1588360762
Name:DAVIS, AMBER (CPD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 W MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2140
Mailing Address - Country:US
Mailing Address - Phone:847-857-5346
Mailing Address - Fax:
Practice Address - Street 1:5039 N TROY ST APT G
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-9487
Practice Address - Country:US
Practice Address - Phone:847-857-5346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4-202224374J00000X
IL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula