Provider Demographics
NPI:1316382104
Name:DAVIS, CHARLOTTE (RN)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
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 1:8548 WILLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:YONGES ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29449-5515
Mailing Address - Country:US
Mailing Address - Phone:843-880-4008
Mailing Address - Fax:843-889-6758
Practice Address - Street 1:8548 WILLTOWN RD
Practice Address - Street 2:
Practice Address - City:YONGES ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29449-5515
Practice Address - Country:US
Practice Address - Phone:843-880-4008
Practice Address - Fax:843-889-6758
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC80443163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse