Provider Demographics
NPI:1316179880
Name:DAVIES, NENNEH VIDA (PMHNP)
Entity type:Individual
Prefix:MS
First Name:NENNEH
Middle Name:VIDA
Last Name:DAVIES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:NENNEH
Other - Middle Name:V
Other - Last Name:DAVIES-MKWAWA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:5300 LONGSHADOW DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-7826
Mailing Address - Country:US
Mailing Address - Phone:614-886-5474
Mailing Address - Fax:
Practice Address - Street 1:5300 LONGSHADOW DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-7826
Practice Address - Country:US
Practice Address - Phone:614-886-5474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2024058287363LP0808X
OH402963363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health