Provider Demographics
NPI:1134417702
Name:DAVIS, LISA ANN (NA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 S WEBB AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-8452
Mailing Address - Country:US
Mailing Address - Phone:931-484-6196
Mailing Address - Fax:931-456-1047
Practice Address - Street 1:131 S WEBB AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-8452
Practice Address - Country:US
Practice Address - Phone:931-484-6196
Practice Address - Fax:931-456-1047
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00006563376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide