Provider Demographics
NPI:1720780992
Name:DAVIS, NATHAN ARCHIE
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:ARCHIE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5652 26TH ST S APT 113
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7729
Mailing Address - Country:US
Mailing Address - Phone:701-367-3175
Mailing Address - Fax:
Practice Address - Street 1:5652 26TH ST S APT 113
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7729
Practice Address - Country:US
Practice Address - Phone:701-367-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant