Provider Demographics
NPI:1659831386
Name:DAVENPORT-WELTER, CHRISTINE EILEEN (MD, MPH)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:EILEEN
Last Name:DAVENPORT-WELTER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:EILEEN
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1441 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-5420
Mailing Address - Country:US
Mailing Address - Phone:208-642-9376
Mailing Address - Fax:208-642-9598
Practice Address - Street 1:840 SW 4TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2638
Practice Address - Country:US
Practice Address - Phone:541-881-2800
Practice Address - Fax:541-881-2825
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61183854207Q00000X
ORMD221691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2134058Medicaid