Provider Demographics
NPI:1245361070
Name:DAVIS, MARYANNE ELOISE (CRN)
Entity type:Individual
Prefix:MRS
First Name:MARYANNE
Middle Name:ELOISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 982
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:OR
Mailing Address - Zip Code:97882-0982
Mailing Address - Country:US
Mailing Address - Phone:541-564-2536
Mailing Address - Fax:
Practice Address - Street 1:80582 UMATILLA RIVER RD
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-6658
Practice Address - Country:US
Practice Address - Phone:541-564-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health