Provider Demographics
NPI:1699009373
Name:DAVIS, JILL LE ANN (RN, IBCLC, RLC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:LE ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 PAUL RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9031
Mailing Address - Country:US
Mailing Address - Phone:614-506-0150
Mailing Address - Fax:614-899-8335
Practice Address - Street 1:6620 PAUL RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9031
Practice Address - Country:US
Practice Address - Phone:614-506-0150
Practice Address - Fax:614-899-8335
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 245011163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant