Provider Demographics
NPI:1790933976
Name:DAVIS, KATHERINE L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:L
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 1:10188 EDWARD CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14129-9713
Mailing Address - Country:US
Mailing Address - Phone:716-532-2887
Mailing Address - Fax:
Practice Address - Street 1:10188 EDWARD CORNERS RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:NY
Practice Address - Zip Code:14129-9713
Practice Address - Country:US
Practice Address - Phone:716-532-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-30
Last Update Date:2008-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174113164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse