Provider Demographics
NPI:1790350429
Name:DAVIS, DEANNA LYN
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 N YARBROUGH DR STE U
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7926
Mailing Address - Country:US
Mailing Address - Phone:915-504-1715
Mailing Address - Fax:
Practice Address - Street 1:1188 N YARBROUGH DR STE U
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7926
Practice Address - Country:US
Practice Address - Phone:915-504-1715
Practice Address - Fax:915-303-7144
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80937237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80937OtherTDLR