Provider Demographics
NPI:1225300049
Name:DAVIS, RESIA RENEE (RN)
Entity Type:Individual
Prefix:MS
First Name:RESIA
Middle Name:RENEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12304 DARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-3749
Mailing Address - Country:US
Mailing Address - Phone:440-317-3778
Mailing Address - Fax:
Practice Address - Street 1:12304 DARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3749
Practice Address - Country:US
Practice Address - Phone:440-317-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 172835163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology