Provider Demographics
NPI:1689990749
Name:DAVIS, ALISA (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MILL CREEK CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6501
Mailing Address - Country:US
Mailing Address - Phone:410-654-0752
Mailing Address - Fax:410-654-1273
Practice Address - Street 1:2500 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-3633
Practice Address - Country:US
Practice Address - Phone:410-951-4188
Practice Address - Fax:410-951-6158
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114508163WA2000X, 163WC1400X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health