Provider Demographics
NPI:1770845505
Name:DAVIS, BRANDY L (STNA)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:L
Last Name:DAVIS
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 1:292 1/2 HANE AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5368
Mailing Address - Country:US
Mailing Address - Phone:740-244-4172
Mailing Address - Fax:
Practice Address - Street 1:292 1/2 HANE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5368
Practice Address - Country:US
Practice Address - Phone:740-244-4172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401185241210374U00000X, 376K00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH401185241210OtherNURSE AID REGISTRY #