Individual
MRS. DIANE L DAVIS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1507 W QUITMAN ST, IUKA, MS 38852-1132
(662) 423-1000
(662) 423-1316
Mailing address
1507 W QUITMAN ST, IUKA, MS 38852-1132
(662) 423-1000
(662) 423-1316
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R866519
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03171239
—
MS
Enumeration date
06/23/2005
Last updated
07/08/2007
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