Provider Demographics
NPI:1275351827
Name:DAVIS, STEPHANIE MARIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
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 1:516 LITTLE WATER FALLS TRL
Mailing Address - Street 2:
Mailing Address - City:FANCY GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24328-4453
Mailing Address - Country:US
Mailing Address - Phone:407-310-3514
Mailing Address - Fax:
Practice Address - Street 1:516 LITTLE WATER FALLS TRL
Practice Address - Street 2:
Practice Address - City:FANCY GAP
Practice Address - State:VA
Practice Address - Zip Code:24328-4453
Practice Address - Country:US
Practice Address - Phone:407-310-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001316325163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse