Provider Demographics
NPI:1841549391
Name:DAVIS, MARY (CNP)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6310
Mailing Address - Country:US
Mailing Address - Phone:740-387-5210
Mailing Address - Fax:740-382-3713
Practice Address - Street 1:320 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6310
Practice Address - Country:US
Practice Address - Phone:740-387-5210
Practice Address - Fax:740-382-3713
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13747-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health