Provider Demographics
NPI:1619217726
Name:DAVIS, JILL CHRISTINE (LPN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CHRISTINE
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 1:117 HAWLEY ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-3903
Mailing Address - Country:US
Mailing Address - Phone:607-723-8306
Mailing Address - Fax:607-723-4087
Practice Address - Street 1:24 CONKEY AVE # 26
Practice Address - Street 2:BOX 126
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1774
Practice Address - Country:US
Practice Address - Phone:607-334-6378
Practice Address - Fax:607-336-1304
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313653164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse