Provider Demographics
NPI:1932602414
Name:DAVIS, DEELLEN MARIE
Entity Type:Individual
Prefix:
First Name:DEELLEN
Middle Name:MARIE
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 1:47 VALLEYVIEW RD APT 137
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-3270
Mailing Address - Country:US
Mailing Address - Phone:254-488-0641
Mailing Address - Fax:
Practice Address - Street 1:47 VALLEYVIEW RD APT 137
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-3270
Practice Address - Country:US
Practice Address - Phone:254-488-0641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant