Provider Demographics
NPI:1760892996
Name:DAVIS, IRENE (LPN)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 E 98TH ST
Mailing Address - Street 2:2J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4063
Mailing Address - Country:US
Mailing Address - Phone:347-501-1287
Mailing Address - Fax:
Practice Address - Street 1:1177 E 98TH ST
Practice Address - Street 2:2J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4063
Practice Address - Country:US
Practice Address - Phone:347-501-1287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295943-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse