Provider Demographics
NPI:1336478098
Name:DAVIS, SARA (LPN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:DAVIS
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 1:784 PIEDMONT ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2557
Mailing Address - Country:US
Mailing Address - Phone:937-527-0408
Mailing Address - Fax:
Practice Address - Street 1:963 XENIA AVE
Practice Address - Street 2:APT. B
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-1676
Practice Address - Country:US
Practice Address - Phone:937-944-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 136344-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse