Provider Demographics
NPI:1962844456
Name:DAVIS, NATASHA DENISE (LPN)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:DENISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:DENISE
Other - Last Name:MONROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4048 SYCAMORE LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4770
Mailing Address - Country:US
Mailing Address - Phone:706-308-6324
Mailing Address - Fax:
Practice Address - Street 1:4048 SYCAMORE LOOP
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4770
Practice Address - Country:US
Practice Address - Phone:706-308-6324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6841164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse