Provider Demographics
NPI:1356772370
Name:DAVIS, ADAM COLEMAN (ARNP)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:COLEMAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 BROADWAY E APT B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4152
Mailing Address - Country:US
Mailing Address - Phone:847-275-4656
Mailing Address - Fax:
Practice Address - Street 1:10024 SE 240TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-5124
Practice Address - Country:US
Practice Address - Phone:253-859-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-01
Last Update Date:2013-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60421875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily