Individual
ELISSA JO DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8941 N RODGERS CT SE, CALEDONIA, MI 49316-8013
(616) 252-5300
(616) 252-5390
Mailing address
5900 BYRON CENTER AVE SW, MEDICAL ADMINISTRATION, WYOMING, MI 49519-9606
(616) 252-3243
(616) 252-0260
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704260086
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704260086
STATE LICENSE
MI
Enumeration date
01/21/2014
Last updated
02/05/2019
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