Provider Demographics
NPI:1679215529
Name:DAVIS, JULIANNE SUSAN (RN)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:SUSAN
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 1:5558 LANDON ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2596
Mailing Address - Country:US
Mailing Address - Phone:564-208-1958
Mailing Address - Fax:360-735-9416
Practice Address - Street 1:1900 E FULTON ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1806
Practice Address - Country:US
Practice Address - Phone:503-538-2108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR098003059RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse