Provider Demographics
NPI:1023277738
Name:DAVIS, CHRYSANTHEMUM M (NP)
Entity type:Individual
Prefix:MS
First Name:CHRYSANTHEMUM
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1551 SOUTH STURDY RD.
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-7883
Mailing Address - Country:US
Mailing Address - Phone:219-531-0200
Mailing Address - Fax:219-531-0045
Practice Address - Street 1:1551 SOUTH STURDY RD.
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7883
Practice Address - Country:US
Practice Address - Phone:219-531-0200
Practice Address - Fax:219-531-0045
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001290B363LF0000X
IN71001290A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily