Provider Demographics
NPI:1043085368
Name:DAVIS, DIANE E
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN FURNACE
Mailing Address - State:OH
Mailing Address - Zip Code:45629-8765
Mailing Address - Country:US
Mailing Address - Phone:740-727-4422
Mailing Address - Fax:
Practice Address - Street 1:275 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN FURNACE
Practice Address - State:OH
Practice Address - Zip Code:45629-8765
Practice Address - Country:US
Practice Address - Phone:740-727-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care