Provider Demographics
NPI:1821337908
Name:DAVENPORT, NORMA JEAN
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:JEAN
Last Name:DAVENPORT
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 1:4510 3RD STREET CIR W APT 516
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1520
Mailing Address - Country:US
Mailing Address - Phone:941-739-5459
Mailing Address - Fax:
Practice Address - Street 1:4510 3RD STREET CIR W APT 516
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1520
Practice Address - Country:US
Practice Address - Phone:941-739-5459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator