Individual
RUSSELL DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1887 AARON DR STE B, TOOELE, UT 84074-8138
(435) 775-9969
Mailing address
1887 N AARON DR, SUITE B, TOOELE, UT 84074
(435) 775-9969
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4988445-4405
UT
Other
Enumeration date
12/15/2016
Last updated
07/20/2018
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