Provider Demographics
NPI:1992793434
Name:DAVIS, DENISE (MS RN NPC)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS RN NPC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CENTER ST
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-2104
Mailing Address - Country:US
Mailing Address - Phone:847-888-3661
Mailing Address - Fax:847-888-9964
Practice Address - Street 1:901 CENTER ST
Practice Address - Street 2:SUITE 3000
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-2104
Practice Address - Country:US
Practice Address - Phone:847-888-3661
Practice Address - Fax:847-888-9964
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041165350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL595940Medicare ID - Type Unspecified
P15055Medicare UPIN