Provider Demographics
NPI:1407342421
Name:DAVIES, JOANNA L (RN)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:L
Last Name:DAVIES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:L
Other - Last Name:MCCARTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:45 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-1131
Mailing Address - Country:US
Mailing Address - Phone:715-460-3119
Mailing Address - Fax:
Practice Address - Street 1:45 19TH ST
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-1131
Practice Address - Country:US
Practice Address - Phone:715-460-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156401-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse