Provider Demographics
NPI:1750432134
Name:DAVIS, MARY ANNE (HOME HEALTH)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:HOME HEALTH
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ANNE
Other - Last Name:DYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2266 SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-3241
Mailing Address - Country:US
Mailing Address - Phone:937-284-7664
Mailing Address - Fax:937-284-7664
Practice Address - Street 1:2266 SEMINOLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-3241
Practice Address - Country:US
Practice Address - Phone:937-284-7664
Practice Address - Fax:937-284-7664
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2318343376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker