Provider Demographics
NPI:1952640138
Name:DAVIS, BRIDGET RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:RENEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7367 CLOVERNOOK AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4473
Mailing Address - Country:US
Mailing Address - Phone:513-213-1449
Mailing Address - Fax:
Practice Address - Street 1:7367 CLOVERNOOK AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4473
Practice Address - Country:US
Practice Address - Phone:513-213-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN118052164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse