Provider Demographics
NPI:1336759059
Name:DAVIS, MELODI S (RN)
Entity type:Individual
Prefix:
First Name:MELODI
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9194 E NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1919
Mailing Address - Country:US
Mailing Address - Phone:720-277-7734
Mailing Address - Fax:
Practice Address - Street 1:9194 E NASSAU AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1919
Practice Address - Country:US
Practice Address - Phone:720-277-7734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1668878163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse