Provider Demographics
NPI:1518743855
Name:DAVIS, CORY (RN)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11210 WINTERHAM RD
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002-4601
Mailing Address - Country:US
Mailing Address - Phone:804-517-8960
Mailing Address - Fax:
Practice Address - Street 1:11210 WINTERHAM RD
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-4601
Practice Address - Country:US
Practice Address - Phone:804-517-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001303861163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency