Provider Demographics
NPI:1407246671
Name:DAVENPORT, JANET (RN)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:
Last Name:DAVENPORT
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 1:471 SILVERSTREET RD
Mailing Address - Street 2:
Mailing Address - City:SILVERSTREET
Mailing Address - State:SC
Mailing Address - Zip Code:29145-8941
Mailing Address - Country:US
Mailing Address - Phone:803-940-7325
Mailing Address - Fax:
Practice Address - Street 1:471 SILVERSTREET RD
Practice Address - Street 2:
Practice Address - City:SILVERSTREET
Practice Address - State:SC
Practice Address - Zip Code:29145-8941
Practice Address - Country:US
Practice Address - Phone:803-940-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC219688163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse