Provider Demographics
NPI:1598170276
Name:DAVIS, JOHN (LPN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10271 DRESDEN RD
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:OH
Mailing Address - Zip Code:43821-9446
Mailing Address - Country:US
Mailing Address - Phone:740-704-4438
Mailing Address - Fax:
Practice Address - Street 1:10271 DRESDEN RD
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:OH
Practice Address - Zip Code:43821-9446
Practice Address - Country:US
Practice Address - Phone:740-704-4438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-21
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN134851-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse