Provider Demographics
NPI:1104954940
Name:DAVIS, DEBORAH THOMAS (LPN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:THOMAS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-3315
Mailing Address - Country:US
Mailing Address - Phone:336-845-7699
Mailing Address - Fax:
Practice Address - Street 1:501 E GREEN DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-6707
Practice Address - Country:US
Practice Address - Phone:336-845-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC033505164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse