Basic Information
| Provider Information | |||||||||
| NPI: | 1659404234 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | DIONE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 S LAKESHORE DR | ||||||||
| Address2: | |||||||||
| City: | RANSOM CANYON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793662409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067483878 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3601 4TH ST | ||||||||
| Address2: | DEPT. OF PEDIATRICS | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794300002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067437337 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 12/29/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 638677 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 163WP0200X | 638677 | TX | N | Nursing Service Providers | Registered Nurse | Pediatrics |
No ID Information.