Provider Demographics
NPI:1194994731
Name:DAVIS, PAMELA J (LPN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:PRIOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:2651 MOUNTS RD.
Mailing Address - Street 2:P.O. BOX 236
Mailing Address - City:ALEXANDIA
Mailing Address - State:OH
Mailing Address - Zip Code:43001-0236
Mailing Address - Country:US
Mailing Address - Phone:740-973-2448
Mailing Address - Fax:
Practice Address - Street 1:2651 MOUNTS RD.
Practice Address - Street 2:
Practice Address - City:ALEXANDIA
Practice Address - State:OH
Practice Address - Zip Code:43001-0236
Practice Address - Country:US
Practice Address - Phone:740-973-2448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH109624164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2362518Medicaid