Provider Demographics
NPI:1811716566
Name:DAVIS, ERIN ELIZABETH
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ELIZABETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ELM ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26377-8900
Mailing Address - Country:US
Mailing Address - Phone:304-314-7947
Mailing Address - Fax:
Practice Address - Street 1:8 ELM ST
Practice Address - Street 2:
Practice Address - City:JACKSONBURG
Practice Address - State:WV
Practice Address - Zip Code:26377-8900
Practice Address - Country:US
Practice Address - Phone:304-314-7947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1821206228Medicaid
WV1356607394Medicaid
WV125553494Medicaid