Provider Demographics
NPI:1881431096
Name:DAVIES, DEVIN MICHAEL (STUDENT)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:MICHAEL
Last Name:DAVIES
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2127
Mailing Address - Country:US
Mailing Address - Phone:630-796-5913
Mailing Address - Fax:
Practice Address - Street 1:2002 N 29TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2127
Practice Address - Country:US
Practice Address - Phone:630-796-5913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program