Provider Demographics
NPI:1316121312
Name:DAVEY, MAKITA (LPN)
Entity type:Individual
Prefix:
First Name:MAKITA
Middle Name:
Last Name:DAVEY
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 1:105 STERLING ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-2524
Mailing Address - Country:US
Mailing Address - Phone:585-647-3321
Mailing Address - Fax:
Practice Address - Street 1:105 STERLING ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-2524
Practice Address - Country:US
Practice Address - Phone:585-647-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290044-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse