Individual
STEPHANIE WILSON DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN
Contact information
Practice address
4555 OGBURN AVE, WINSTON SALEM, NC 27105-2726
(336) 703-4273
Mailing address
200 E 2ND AVE, GASTONIA, NC 28052-4358
(704) 874-1904
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2001029398
MO
363L00000X
Nurse Practitioner
Primary
5012785
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100415260A
—
KS
05
—
425770807
—
MO
Enumeration date
04/27/2006
Last updated
02/19/2020
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