Provider Demographics
NPI:1801206263
Name:DAVIS, JOYCE
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
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 1:625 N EUCLID AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1690
Mailing Address - Country:US
Mailing Address - Phone:314-300-8503
Mailing Address - Fax:314-300-8503
Practice Address - Street 1:625 N EUCLID AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1690
Practice Address - Country:US
Practice Address - Phone:314-300-8503
Practice Address - Fax:314-300-8503
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO463005758374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide