Provider Demographics
NPI:1285961557
Name:DAVIS, LORRAINE C (RN)
Entity type:Individual
Prefix:MISS
First Name:LORRAINE
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LORRAINE
Other - Middle Name:C
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:355 SPINNAKER LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1770
Mailing Address - Country:US
Mailing Address - Phone:585-216-5978
Mailing Address - Fax:
Practice Address - Street 1:355 SPINNAKER LN
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1770
Practice Address - Country:US
Practice Address - Phone:585-216-5978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-07
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY519120-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse