Provider Demographics
NPI:1205689809
Name:DAVIS, JENNIFER N (IN HOME CARE PROVIDE)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:DAVIS
Suffix:
Gender:F
Credentials:IN HOME CARE PROVIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 BERETTA DR
Mailing Address - Street 2:
Mailing Address - City:EUTAWVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29048-8600
Mailing Address - Country:US
Mailing Address - Phone:843-367-3431
Mailing Address - Fax:
Practice Address - Street 1:178 BERETTA DR
Practice Address - Street 2:
Practice Address - City:EUTAWVILLE
Practice Address - State:SC
Practice Address - Zip Code:29048-8600
Practice Address - Country:US
Practice Address - Phone:843-367-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3747A0650X
SCIHCP-21223747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider