Provider Demographics
NPI:1588847875
Name:DAVIS, LINDA MAE (RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MAE
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 1:7733 CROTON RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-8193
Mailing Address - Country:US
Mailing Address - Phone:740-966-6055
Mailing Address - Fax:740-966-6055
Practice Address - Street 1:7733 CROTON RD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-8193
Practice Address - Country:US
Practice Address - Phone:740-966-6055
Practice Address - Fax:740-966-6055
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN239985163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse