Provider Demographics
NPI:1528370186
Name:DAVIS, DIANE M (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
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 1:11819 SE WILLIAM OTTY RD
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-8290
Mailing Address - Country:US
Mailing Address - Phone:503-698-5334
Mailing Address - Fax:503-698-5316
Practice Address - Street 1:11819 SE WILLIAM OTTY RD
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-8290
Practice Address - Country:US
Practice Address - Phone:503-698-5334
Practice Address - Fax:503-698-5316
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-11
Last Update Date:2010-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080045760RN163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management