Provider Demographics
NPI:1851954341
Name:DAVIS, ALOYSIUS DE'MON SR (LPN SKILLED CARE)
Entity Type:Individual
Prefix:MR
First Name:ALOYSIUS
Middle Name:DE'MON
Last Name:DAVIS
Suffix:SR
Gender:M
Credentials:LPN SKILLED CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-1356
Mailing Address - Country:US
Mailing Address - Phone:913-963-0021
Mailing Address - Fax:
Practice Address - Street 1:6240 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1356
Practice Address - Country:US
Practice Address - Phone:913-963-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-27714-122164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse