Provider Demographics
NPI:1457090342
Name:DAVIS, CARMEN RENE (MSN, RN, CCRN, CNS-B)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:RENE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSN, RN, CCRN, CNS-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8467 CLEW CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8957
Mailing Address - Country:US
Mailing Address - Phone:317-696-6754
Mailing Address - Fax:
Practice Address - Street 1:550 UNIVERSITY BLVD # UH6611
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-948-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2009009583364S00000X
IN28145460163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist