Individual
MR. SCOTT J DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
1310 N MAIN ST STE 200, SANDWICH, IL 60548-1397
(815) 786-7150
(815) 786-3785
Mailing address
1310 N MAIN ST STE 200, SANDWICH, IL 60548-1397
(815) 786-7150
(815) 786-3785
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209008413
IL
363LF0000X
Family Nurse Practitioner
209.008413
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F400101031
MEDICARE INDIVIDUAL
IL
01
—
IL6309
MEDICARE GROUP
IL
Enumeration date
11/23/2010
Last updated
03/25/2020
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