Provider Demographics
NPI:1467743773
Name:DAVIS, MARIA MEKOE
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:MEKOE
Last Name:DAVIS
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 1:265 N THOMAS RD APT 219B
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1777
Mailing Address - Country:US
Mailing Address - Phone:216-338-7164
Mailing Address - Fax:
Practice Address - Street 1:265 N THOMAS RD APT 219B
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1777
Practice Address - Country:US
Practice Address - Phone:216-338-7164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 143992- M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse