Provider Demographics
NPI:1396405619
Name:DAVIDSON, ADORNA DAREESE
Entity Type:Individual
Prefix:
First Name:ADORNA
Middle Name:DAREESE
Last Name:DAVIDSON
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 1:14203 LONG MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-4598
Mailing Address - Country:US
Mailing Address - Phone:512-630-4198
Mailing Address - Fax:
Practice Address - Street 1:14203 LONG MEADOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-4598
Practice Address - Country:US
Practice Address - Phone:512-630-4198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331359164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse