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Individual

JUDITH A DAVENPORT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
5605 N MACARTHUR BLVD, STE. 220, IRVING, TX 75038-2617
(972) 714-0007
(972) 714-0009
Mailing address
5605 N MACARTHUR BLVD, STE. 220, IRVING, TX 75038-2617
(972) 714-0007
(972) 714-0009

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
508432
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
089061804
TX
01
113718318
TAX ID
TX
01
562365185
TAX ID
TX
01
7419463831
TAX ID
TX
01
743018935
TAX ID NO
TX
01
81143U
BCBS
TX
01
83562U
BCBS
TX
01
83892U
BCBS
TX
01
85385U
BCBS
TX
01
88421C
BCBS
TX
Enumeration date
09/13/2006
Last updated
07/08/2013
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