Provider Demographics
NPI:1477767358
Name:DAVIDSON, BETTY SUE
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:SUE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:SUE
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4614 ANNAPOLIS AVE
Mailing Address - Street 2:SAME
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45416-1543
Mailing Address - Country:US
Mailing Address - Phone:937-559-0859
Mailing Address - Fax:
Practice Address - Street 1:4614 ANNAPOLIS AVE
Practice Address - Street 2:SAME
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416-1543
Practice Address - Country:US
Practice Address - Phone:937-559-0859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2506103376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2506103OtherPROVIDERNUMBER