Provider Demographics
NPI:1679718597
Name:DAVIS, VICTORIA LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LYNN
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 1:9732 MESKILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MI
Mailing Address - Zip Code:48063-1708
Mailing Address - Country:US
Mailing Address - Phone:810-305-2544
Mailing Address - Fax:810-305-2544
Practice Address - Street 1:9732 MESKILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MI
Practice Address - Zip Code:48063
Practice Address - Country:US
Practice Address - Phone:810-305-2544
Practice Address - Fax:810-305-2544
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703096455164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse