Individual
CONNIE L. DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
208 HOSPITAL PARKWAY, MOUNT VERNON, WA 98274
(360) 428-8260
(360) 428-8576
Mailing address
1400 E. KINCAID STREET, ATTN: CREDENTIALING, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD00025078
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8303687
—
WA
01
—
9149
INTERNAL ID-MOTOR VEHICLE ID
—
Enumeration date
10/27/2006
Last updated
03/13/2015
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