Provider Information for 1316652571
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SUSAN DANELLE DAVIS
Sex: Female
NPI: 1316652571
Last Updated: 2023-01-20
Certification Date: 2023-01-20
Certification Date: 2023-01-20
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1316652571 | ||||||||||||||
| Enumeration Date | 2023-01-20 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 1610 WILSON CT EUGENE, OR 97402-3361 United States Phone: 541-243-3133 | Fax: | ||||||||||||||
| Primary Practice Address | 29398 RECOVERY WAY JUNCTION CITY, OR 97448-8447 United States Phone: 541-465-2907 | Fax: | ||||||||||||||
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