Davenport, Mike S

Davenport, Mike S is an individual health care provider with primary practice located at 206 S Washington St , Mc Leansboro IL 62859-1139. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is his primary health care specialty. Davenport, Mike S can be contacted via phone (618) 643-2835.

Contact Information

Primary practice address
206 S Washington St Mc Leansboro IL 62859-1139
Phone: (618) 643-2835
Fax: (618) 643-2891
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209.005569 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209.005569 Illinois

Profile Details

NPI number 1295789576
LBN Legal business name Davenport, Mike S
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 20th, 2006
Last updated Apr 22nd, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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