Provider Demographics
NPI:1972667798
Name:DAVIS, DIANNE KATHLEEN (RNFA)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:KATHLEEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 QUAIL MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-9251
Mailing Address - Country:US
Mailing Address - Phone:209-551-5828
Mailing Address - Fax:
Practice Address - Street 1:2345 QUAIL MEADOW DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-9251
Practice Address - Country:US
Practice Address - Phone:209-551-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569775163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant