Individual
MRS. CAROL DE VRIES DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
5324 JEWEL LN, STURGEON BAY, WI 54235-2355
(920) 743-6490
Mailing address
5324 JEWEL LN, STURGEON BAY, WI 54235-2355
(920) 743-6490
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38345100
—
WI
Enumeration date
11/06/2006
Last updated
07/09/2007
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