Provider Demographics
NPI:1558807537
Name:DAVIS, NIKKI GIOVANNI (LPN)
Entity Type:Individual
Prefix:MISS
First Name:NIKKI
Middle Name:GIOVANNI
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 THIRD AVE
Mailing Address - Street 2:9D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-4473
Mailing Address - Country:US
Mailing Address - Phone:212-495-9952
Mailing Address - Fax:
Practice Address - Street 1:3480 THIRD AVE
Practice Address - Street 2:9D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-4473
Practice Address - Country:US
Practice Address - Phone:212-495-9952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280979164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse