Provider Demographics
NPI:1962122887
Name:DAVIS, AVIS ROSE (DNP, RN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:AVIS
Middle Name:ROSE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DNP, RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 N LUCILLE ST
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6405
Mailing Address - Country:US
Mailing Address - Phone:907-357-5157
Mailing Address - Fax:907-357-5159
Practice Address - Street 1:1021 N LUCILLE ST
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6405
Practice Address - Country:US
Practice Address - Phone:907-357-5157
Practice Address - Fax:907-357-5159
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ141218163WP0200X
AZ279395363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WP0200XNursing Service ProvidersRegistered NursePediatrics