Provider Demographics
NPI:1710115514
Name:DAVIS, NANCY LENZEN (MT-BC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LENZEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 SAM GREEN RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-1637
Mailing Address - Country:US
Mailing Address - Phone:860-742-9366
Mailing Address - Fax:860-742-9366
Practice Address - Street 1:160 SAM GREEN RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-1637
Practice Address - Country:US
Practice Address - Phone:860-742-9366
Practice Address - Fax:860-742-9366
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist