Provider Demographics
NPI:1639775976
Name:DAVIS, CHANAE LYNNETTE
Entity Type:Individual
Prefix:
First Name:CHANAE
Middle Name:LYNNETTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 WESTOVER HILLS BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4530
Mailing Address - Country:US
Mailing Address - Phone:240-419-1914
Mailing Address - Fax:
Practice Address - Street 1:609 WESTOVER HILLS BLVD APT B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4530
Practice Address - Country:US
Practice Address - Phone:240-419-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1201137980224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist