Provider Demographics
NPI:1336857382
Name:DAVIS, CHARLOTTE (RN)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:
Other - Last Name:FRAZEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2909 NE 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-7989
Mailing Address - Country:US
Mailing Address - Phone:714-421-0226
Mailing Address - Fax:
Practice Address - Street 1:2909 NE 130TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-7989
Practice Address - Country:US
Practice Address - Phone:714-421-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202100801RN163WC1500X
CA95086405163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience