Provider Demographics
NPI:1225524432
Name:DAVIS, DORA DAVIS (RN)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:DAVIS
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:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:VARNEY
Mailing Address - State:WV
Mailing Address - Zip Code:25696-0255
Mailing Address - Country:US
Mailing Address - Phone:304-426-8540
Mailing Address - Fax:
Practice Address - Street 1:48 MYSTERY MT ROAD
Practice Address - Street 2:
Practice Address - City:DELBARTON
Practice Address - State:WV
Practice Address - Zip Code:25670
Practice Address - Country:US
Practice Address - Phone:304-426-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV67794163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse