Provider Demographics
NPI:1124610787
Name:DAVIS, LONRAE DIONNE
Entity type:Individual
Prefix:MRS
First Name:LONRAE
Middle Name:DIONNE
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 1:4903 N 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5205
Mailing Address - Country:US
Mailing Address - Phone:414-803-5081
Mailing Address - Fax:
Practice Address - Street 1:4903 N 40TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5205
Practice Address - Country:US
Practice Address - Phone:414-803-5081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
No173C00000XOther Service ProvidersReflexologist