Provider Demographics
NPI:1831485846
Name:DAVIS, JENNIFER LELIA (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LELIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:22620 SE 216TH PL STE E
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6346
Mailing Address - Country:US
Mailing Address - Phone:425-200-4546
Mailing Address - Fax:425-523-9167
Practice Address - Street 1:22620 SE 216TH PL STE E
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6346
Practice Address - Country:US
Practice Address - Phone:425-200-4546
Practice Address - Fax:425-523-9167
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP605734712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology