Provider Demographics
NPI:1760883292
Name:DAVIS, JEANNIE R (RN,IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 COMMONWEALTH DR STE 310
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4837
Mailing Address - Country:US
Mailing Address - Phone:864-752-0517
Mailing Address - Fax:864-234-7961
Practice Address - Street 1:131 COMMONWEALTH DR STE 310
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4837
Practice Address - Country:US
Practice Address - Phone:864-752-0517
Practice Address - Fax:864-234-7961
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCL-19715174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN