Russell Davis
Nurse Practitioner, Family in Tooele, UT. Individual provider (NPI-1).
NPI number1982148581
StatusActive
Last updated in NPPESJul 20, 2018
Details
- NPI
- 1982148581
- Entity type
- Individual (NPI-1)
- Name
- Russell Davis
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 15, 2016
- Last updated
- Jul 20, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 4988445-4405 | UT | Yes |
Practice location
1887 Aaron Dr Ste BTooele, UT 84074-8138
Phone 435-775-9969
Mailing address
1887 N Aaron DrSuite B
Tooele, UT 84074
Phone 435-775-9969
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