Provider Demographics
NPI:1750887451
Name:DAVIS, BRELYNN A (RN)
Entity type:Individual
Prefix:
First Name:BRELYNN
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 N MILTON SHOPIERE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-8643
Mailing Address - Country:US
Mailing Address - Phone:608-931-4786
Mailing Address - Fax:
Practice Address - Street 1:4815 BAUTISTA DR
Practice Address - Street 2:
Practice Address - City:MC FARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-8737
Practice Address - Country:US
Practice Address - Phone:608-575-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI239509163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse