Provider Demographics
NPI:1073388096
Name:DAVIES, THERESA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:DAVIES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-1248
Mailing Address - Country:US
Mailing Address - Phone:440-855-0183
Mailing Address - Fax:
Practice Address - Street 1:520 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-1248
Practice Address - Country:US
Practice Address - Phone:440-855-0183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine