Provider Demographics
NPI:1396155180
Name:DAVIS/VIRE, SEMAJ N (LPN)
Entity type:Individual
Prefix:
First Name:SEMAJ
Middle Name:N
Last Name:DAVIS/VIRE
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 1:115 BROOKLEA PL
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-2817
Mailing Address - Country:US
Mailing Address - Phone:315-885-8737
Mailing Address - Fax:
Practice Address - Street 1:115 BROOKLEA PL
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207-2817
Practice Address - Country:US
Practice Address - Phone:315-885-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2711251164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse