Provider Demographics
NPI:1831562651
Name:DAVIS, MICHELLE (CRNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2400
Mailing Address - Country:US
Mailing Address - Phone:330-677-3628
Mailing Address - Fax:330-677-3626
Practice Address - Street 1:307 W MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2400
Practice Address - Country:US
Practice Address - Phone:330-677-3628
Practice Address - Fax:330-677-3626
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 18284 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner