| Doctor Name: | COLLEEN DAVENPORT |
| NPI Number: | 1003223694 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | AP60443726 |
| Business Practice Address: | 9601 Steilacoom Blvd Sw, Bldg 27 Lakewood, WA - 984987212 |
| Business Phone Number: | 2535895334 |
| Business Fax Number: | 2535841508 |
| Mailing Address: | 9601 Steilacoom Blvd Sw, Bldg 27, LAKEWOOD |
| State: | WA |
| Postal Code: | 984987212 |
| Phone Number: | 2535895334 |
| Fax Number: | 2535841508 |
| NPI Enumeration Date: | 07/16/2014 |
| NPI Last Update Date: | 02/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | AP60443726 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |