Provider Demographics
NPI:1407280993
Name:DAVIS, BERTHA (RN)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:
Last Name:DAVIS
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 1:31 SAINT JACOB ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-4836
Mailing Address - Country:US
Mailing Address - Phone:585-474-3696
Mailing Address - Fax:
Practice Address - Street 1:281 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-2927
Practice Address - Country:US
Practice Address - Phone:585-324-5915
Practice Address - Fax:585-324-5924
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY548418163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse