Individual
MS. JOAN ILENE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4502 N CENTRAL AVE, PHOENIX, AZ 85012-1817
(602) 499-8357
Mailing address
6128 N 12TH WAY, PHOENIX, AZ 85014-1726
(602) 212-1290
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
389
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
781270
AHCCCS NUMBER
AZ
Enumeration date
08/16/2006
Last updated
07/08/2007
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