Provider Demographics
NPI:1861639544
Name:DAVIS, KATHLEEN LADONNA (LPN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LADONNA
Last Name:DAVIS
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 1:7658 N 78TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-3962
Mailing Address - Country:US
Mailing Address - Phone:414-207-2410
Mailing Address - Fax:
Practice Address - Street 1:7658 N 78TH ST APT 8
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-3962
Practice Address - Country:US
Practice Address - Phone:414-207-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33306164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse