Provider Demographics
NPI:1821493610
Name:DAVIS, RYAN LOUIS (LPN)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:LOUIS
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 111TH ST
Mailing Address - Street 2:APT. 1204
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3042
Mailing Address - Country:US
Mailing Address - Phone:347-931-5048
Mailing Address - Fax:
Practice Address - Street 1:420 E 111TH ST
Practice Address - Street 2:APT. 1204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3042
Practice Address - Country:US
Practice Address - Phone:347-931-5048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316637-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse