Individual
W CHRISTINE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
217 S ADAMS ST, GOLCONDA, IL 62938
(618) 683-3781
(618) 683-5802
Mailing address
PO BOX 3008, 1250 CEDAR COURT, CARBONDALE, IL 62903
(618) 457-0450
(618) 457-7329
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209004159
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209004159
—
IL
Enumeration date
02/05/2007
Last updated
08/07/2018
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