Provider Demographics
NPI:1427746684
Name:DAVENPORT, ANNTOINETTE N/A (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANNTOINETTE
Middle Name:N/A
Last Name:DAVENPORT
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 1:20 3RD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-4460
Mailing Address - Country:US
Mailing Address - Phone:973-277-0972
Mailing Address - Fax:
Practice Address - Street 1:248 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2505
Practice Address - Country:US
Practice Address - Phone:201-998-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP04892900164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse