Provider Demographics
NPI:1760007967
Name:DAVIDSON, DIONNE NIKOLE (STNA)
Entity Type:Individual
Prefix:
First Name:DIONNE
Middle Name:NIKOLE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44902-7750
Mailing Address - Country:US
Mailing Address - Phone:740-223-9247
Mailing Address - Fax:
Practice Address - Street 1:816 WINDSOR ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6262
Practice Address - Country:US
Practice Address - Phone:740-244-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401499130313374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide