Provider Demographics
NPI:1457423089
Name:DAVIS, RITA M (RN, MA)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 235TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-8084
Mailing Address - Country:US
Mailing Address - Phone:319-385-4187
Mailing Address - Fax:319-986-2053
Practice Address - Street 1:1652 235TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-8084
Practice Address - Country:US
Practice Address - Phone:319-385-4187
Practice Address - Fax:319-986-2053
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA049879101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health