Provider Demographics
NPI:1629028303
Name:DAVIS, TERESA LEE (CNP)
Entity Type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:LEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 AGLER ROAD
Mailing Address - Street 2:STE 2400
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219
Mailing Address - Country:US
Mailing Address - Phone:614-428-5553
Mailing Address - Fax:614-428-5515
Practice Address - Street 1:3433 AGLER ROAD
Practice Address - Street 2:STE 2400
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219
Practice Address - Country:US
Practice Address - Phone:614-428-5553
Practice Address - Fax:614-428-5515
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP08448363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health