Provider Demographics
NPI:1538604160
Name:DAVIS, ADAM MYKEL
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:MYKEL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3690 S ROTHCHILD CIR
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-4065
Mailing Address - Country:US
Mailing Address - Phone:801-875-7008
Mailing Address - Fax:
Practice Address - Street 1:3690 S ROTHCHILD CIR
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-4065
Practice Address - Country:US
Practice Address - Phone:801-875-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTUT000380851112374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide