Provider Demographics
NPI:1104461615
Name:DAVIS, VINIA MAE
Entity type:Individual
Prefix:
First Name:VINIA
Middle Name:MAE
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 1:6784 E BLUE GRASS TRL
Mailing Address - Street 2:
Mailing Address - City:BLAND
Mailing Address - State:VA
Mailing Address - Zip Code:24315-5341
Mailing Address - Country:US
Mailing Address - Phone:276-722-0249
Mailing Address - Fax:
Practice Address - Street 1:2763 WALKERS CREEK RD
Practice Address - Street 2:
Practice Address - City:BLAND
Practice Address - State:VA
Practice Address - Zip Code:24315-5309
Practice Address - Country:US
Practice Address - Phone:276-688-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty