Provider Demographics
NPI:1952707473
Name:DAVILA-HERNANDEZ, ELLA
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:DAVILA-HERNANDEZ
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:PO BOX 896199
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-4358
Mailing Address - Country:US
Mailing Address - Phone:833-963-1364
Mailing Address - Fax:605-942-7505
Practice Address - Street 1:128 E PLAZA DR STE 3
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-8000
Practice Address - Country:US
Practice Address - Phone:980-444-2630
Practice Address - Fax:980-444-2631
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily