Basic Information
| Provider Information | |||||||||
| NPI: | 1578981338 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | ANNAGRETA | ||||||||
| MiddleName: | BOWEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5215 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984150215 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 315 MARTIN LUTHER KING JR WAY | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534038327 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2014 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | R14-2014 | NM | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | OP60741567 | WA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.