Provider Demographics
NPI:1497319198
Name:DAVIS, ROBERT RALPH (LPN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RALPH
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 ALBANY POST RD
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:NY
Mailing Address - Zip Code:12525-5504
Mailing Address - Country:US
Mailing Address - Phone:845-389-3554
Mailing Address - Fax:
Practice Address - Street 1:1222 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:NY
Practice Address - Zip Code:12525-5504
Practice Address - Country:US
Practice Address - Phone:845-532-7218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329471164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse