Provider Demographics
NPI:1962066639
Name:DAVIS, DOMINYSE (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:DR
First Name:DOMINYSE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 N BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5210
Mailing Address - Country:US
Mailing Address - Phone:765-400-1800
Mailing Address - Fax:765-400-1840
Practice Address - Street 1:3413 N BRIARWOOD LN
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5210
Practice Address - Country:US
Practice Address - Phone:765-400-1800
Practice Address - Fax:765-400-1840
Is Sole Proprietor?:No
Enumeration Date:2019-04-27
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008981A363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care