Provider Demographics
NPI:1326306069
Name:DAVIS, RAQUEL ANITA (PMHNP)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ANITA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 BROADWAY AVE
Mailing Address - Street 2:APT 303
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3643
Mailing Address - Country:US
Mailing Address - Phone:216-376-2916
Mailing Address - Fax:
Practice Address - Street 1:22072 MARBERRY CMNS
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-6800
Practice Address - Country:US
Practice Address - Phone:216-376-2916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0036127363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health