Most Relevant Information
Provider Data
| NPI Number: | 1003647942 |
| Provider Name: | SOPHOAN DAVIS |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 61154 |
Most Important Dates
| Enumeration Date: | 08/12/2024 |
| Last Updated: | 08/12/2024 |
Provider Practice Location
8615 BOUVARDIA AVE NW
ALBUQUERQUE
NM
871204271
Practice Location Phone/Fax
| Phone: | 7576419637 |
| Fax: |
Provider Mailing Location
8615 BOUVARDIA AVE NW
ALBUQUERQUE
NM
871204271
Provider Mailing Phone/Fax
| Phone: | 7576419637 |
| Fax: |