Provider Demographics
NPI:1760816193
Name:DAVIS, ROSALIE V (RN)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:V
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 1:3813 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47302-5758
Mailing Address - Country:US
Mailing Address - Phone:765-751-3300
Mailing Address - Fax:765-751-1115
Practice Address - Street 1:3813 S MADISON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-5758
Practice Address - Country:US
Practice Address - Phone:765-751-3300
Practice Address - Fax:765-751-1115
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28102876A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse