Provider Demographics
NPI:1023453164
Name:DAVIS, SELENA (RN)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:COWPENS
Mailing Address - State:SC
Mailing Address - Zip Code:29330-9784
Mailing Address - Country:US
Mailing Address - Phone:864-279-6304
Mailing Address - Fax:864-279-6373
Practice Address - Street 1:341 FOSTER ST
Practice Address - Street 2:
Practice Address - City:COWPENS
Practice Address - State:SC
Practice Address - Zip Code:29330-9784
Practice Address - Country:US
Practice Address - Phone:864-279-6304
Practice Address - Fax:864-279-6373
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC41579163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool