Provider Demographics
NPI:1225430846
Name:DAVIS, EASTHER (STNA)
Entity Type:Individual
Prefix:
First Name:EASTHER
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 TROWBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1349
Mailing Address - Country:US
Mailing Address - Phone:216-704-0511
Mailing Address - Fax:
Practice Address - Street 1:3945 TROWBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1349
Practice Address - Country:US
Practice Address - Phone:216-704-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400916330509376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide