Provider Demographics
NPI:1518162494
Name:DAVIS, DEBORAH LEES (RN)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LEES
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 LOTZ WAY
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-2654
Mailing Address - Country:US
Mailing Address - Phone:707-580-7849
Mailing Address - Fax:
Practice Address - Street 1:1015 LOTZ WAY
Practice Address - Street 2:
Practice Address - City:SUISUN CITY
Practice Address - State:CA
Practice Address - Zip Code:94585-2654
Practice Address - Country:US
Practice Address - Phone:707-580-7849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101YM0800X
CAA4785151163WP0200X, 163WH0200X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator