Provider Demographics
NPI:1558939306
Name:DAVIS, TONIA LEA (LPN)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:LEA
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 1:412 W RUDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IN
Mailing Address - Zip Code:47558-5697
Mailing Address - Country:US
Mailing Address - Phone:812-486-9746
Mailing Address - Fax:
Practice Address - Street 1:1694 TROY RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-8216
Practice Address - Country:US
Practice Address - Phone:812-254-3800
Practice Address - Fax:812-254-3801
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27041416A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse