Provider Demographics
NPI:1740718378
Name:DAVIS, CHRISTINE ELIZABETH (RN, BSN, AGNP-C, LMT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, BSN, AGNP-C, LMT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ELIZABETH
Other - Last Name:JEZIORSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN, RN, LMT
Mailing Address - Street 1:901 SWEET JULIET WAY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4559
Mailing Address - Country:US
Mailing Address - Phone:716-553-4707
Mailing Address - Fax:
Practice Address - Street 1:903 SWEET JULIET WAY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4559
Practice Address - Country:US
Practice Address - Phone:716-553-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10791225700000X
SC24295363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist