Provider Demographics
NPI:1245715366
Name:DAVIS, RICHINA MK (LPN)
Entity type:Individual
Prefix:
First Name:RICHINA
Middle Name:MK
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59110 E HIGHWAY 224
Mailing Address - Street 2:
Mailing Address - City:ESTACADA
Mailing Address - State:OR
Mailing Address - Zip Code:97023-9305
Mailing Address - Country:US
Mailing Address - Phone:503-936-9647
Mailing Address - Fax:
Practice Address - Street 1:59110 E HIGHWAY 224
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-9305
Practice Address - Country:US
Practice Address - Phone:503-936-9647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201807395LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse