Individual
MIKE S DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
206 S WASHINGTON ST, MC LEANSBORO, IL 62859-1139
(618) 643-2835
(618) 643-2891
Mailing address
206 S WASHINGTON ST, MC LEANSBORO, IL 62859-1139
(618) 643-2835
(618) 643-2891
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.005569
IL
363LF0000X
Family Nurse Practitioner
209.005569
IL
Other
Enumeration date
05/20/2006
Last updated
04/22/2022
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