Provider Demographics
NPI:1093965071
Name:DAVIS, HEATHER NOELLE (LPN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:NOELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:NOELLE
Other - Last Name:LINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:27 SHEPHERD PL
Mailing Address - Street 2:APT 2B
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5441
Mailing Address - Country:US
Mailing Address - Phone:315-886-6790
Mailing Address - Fax:
Practice Address - Street 1:27 SHEPHERD PL
Practice Address - Street 2:APT 2B
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5441
Practice Address - Country:US
Practice Address - Phone:315-886-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280406164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse