Provider Demographics
NPI:1881980712
Name:DAVIS, CHARLOTTE TATUM (RN)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:TATUM
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 1:21810 BURBANK HL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-1677
Mailing Address - Country:US
Mailing Address - Phone:210-698-1836
Mailing Address - Fax:210-698-1836
Practice Address - Street 1:21810 BURBANK HL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-1677
Practice Address - Country:US
Practice Address - Phone:210-698-1836
Practice Address - Fax:210-698-1836
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX639096163WA2000X, 163WC1500X, 163WI0600X, 163WP0808X, 163WH0200X, 163W00000X, 163WN1003X, 163WX0106X, 373H00000X, 171M00000X, 174H00000X, 225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor