Provider Demographics
NPI:1033086731
Name:DAVIS, ANGELA J (RN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
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 1:24225 W. 9 MILE RD.
Mailing Address - Street 2:STE 140 #333
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033
Mailing Address - Country:US
Mailing Address - Phone:248-914-3639
Mailing Address - Fax:
Practice Address - Street 1:24225 W. 9 MILE RD.
Practice Address - Street 2:STE 140 #333
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033
Practice Address - Country:US
Practice Address - Phone:248-914-3639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704281675163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse