Provider Demographics
NPI:1326817321
Name:DAVIDS, BRIANA ZOE
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:ZOE
Last Name:DAVIDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4958 FULLER AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-4740
Mailing Address - Country:US
Mailing Address - Phone:616-717-2899
Mailing Address - Fax:616-608-3713
Practice Address - Street 1:415 ANDOVER ST SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49548-7674
Practice Address - Country:US
Practice Address - Phone:616-717-2899
Practice Address - Fax:616-608-3713
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care HomeGroup - Single Specialty