Provider Demographics
NPI:1518274414
Name:DAVILA, MICHELLE (FNP, DNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:FNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3377 RIVERBEND DR STE 420
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-8807
Mailing Address - Country:US
Mailing Address - Phone:541-222-8500
Mailing Address - Fax:541-222-6435
Practice Address - Street 1:3377 RIVERBEND DR STE 420
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8807
Practice Address - Country:US
Practice Address - Phone:541-222-8500
Practice Address - Fax:541-222-6435
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201250099NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500649237Medicaid