Provider Demographics
NPI:1093964108
Name:DAVIS, EMILY NOELLE
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:NOELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:NOELLE
Other - Last Name:DAHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17092 SANDRA LEE LN # B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4310
Mailing Address - Country:US
Mailing Address - Phone:909-367-9941
Mailing Address - Fax:
Practice Address - Street 1:17092 SANDRA LEE LN # B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-4310
Practice Address - Country:US
Practice Address - Phone:909-367-9941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator