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Individual
MRS. LORRAINE THERESA DAVIS
Active
Individual
MRS. LORRAINE THERESA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-02452
KS
363A00000X
Physician Assistant
PT796
WY
363AM0700X
Medical Physician Assistant
PT796
WY
363AS0400X
Surgical Physician Assistant
PT796
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710020367
—
CA
05
—
1710020367
—
KS
Enumeration date
02/14/2007
Last updated
02/16/2022
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