Provider Demographics
NPI:1871969626
Name:DAVIS, HELENA (FNP-BC)
Entity type:Individual
Prefix:
First Name:HELENA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9654 W 131ST STREET
Mailing Address - Street 2:UNIT 205
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464
Mailing Address - Country:US
Mailing Address - Phone:773-844-6869
Mailing Address - Fax:708-575-2876
Practice Address - Street 1:9654 W 131ST ST UNIT 205
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-1640
Practice Address - Country:US
Practice Address - Phone:708-480-2650
Practice Address - Fax:708-575-2876
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013064363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208013064OtherLICENSE