Provider Demographics
NPI:1780097162
Name:DAVILA, KANIKA (LPN)
Entity type:Individual
Prefix:
First Name:KANIKA
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4921
Mailing Address - Country:US
Mailing Address - Phone:216-577-1300
Mailing Address - Fax:
Practice Address - Street 1:3314 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-4921
Practice Address - Country:US
Practice Address - Phone:216-577-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140563164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse