Provider Demographics
NPI:1033795109
Name:DAVENPORT, KAREN G
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:G
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:JANE
Other - Last Name:GIBBONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 CREEK HILL LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1125
Mailing Address - Country:US
Mailing Address - Phone:585-737-5063
Mailing Address - Fax:
Practice Address - Street 1:127 CREEK HILL LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-1125
Practice Address - Country:US
Practice Address - Phone:585-737-5063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist