Provider Demographics
NPI:1255720264
Name:DAVIS, GINGER (CNP)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 E MAIN ST
Mailing Address - Street 2:PO BOX 2563
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4056
Mailing Address - Country:US
Mailing Address - Phone:740-687-8990
Mailing Address - Fax:740-687-8230
Practice Address - Street 1:618 PLEASANTVILLE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3312
Practice Address - Country:US
Practice Address - Phone:740-689-6833
Practice Address - Fax:740-689-6827
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA17180NP363L00000X
OHRN.257488163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0120716Medicaid
OHH283250Medicare PIN