Provider Demographics
NPI:1386935690
Name:DAVIS, PATRICIA MICHELE (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MICHELE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:SUTHERLAND
Mailing Address - State:NE
Mailing Address - Zip Code:69165-0724
Mailing Address - Country:US
Mailing Address - Phone:308-386-8584
Mailing Address - Fax:
Practice Address - Street 1:741 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:SUTHERLAND
Practice Address - State:NE
Practice Address - Zip Code:69165-0724
Practice Address - Country:US
Practice Address - Phone:308-386-8584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE50890163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025590100Medicaid