Provider Demographics
NPI:1982467411
Name:DAVIS, RUBY L
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:L
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 1:3243 B LONDON HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-8762
Mailing Address - Country:US
Mailing Address - Phone:740-644-8299
Mailing Address - Fax:
Practice Address - Street 1:2596 1/2 GRATIOT RD SE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43056-9314
Practice Address - Country:US
Practice Address - Phone:740-763-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant