Provider Demographics
NPI:1326699869
Name:DAVIS, LISA M (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:DAVIS-OVERTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:295 SUMPTER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-2712
Mailing Address - Country:US
Mailing Address - Phone:347-866-5803
Mailing Address - Fax:
Practice Address - Street 1:295 SUMPTER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-2712
Practice Address - Country:US
Practice Address - Phone:347-866-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY415028163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool