Provider Demographics
NPI:1003814468
Name:DAVIS, LASONYA ADELE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:DR
First Name:LASONYA
Middle Name:ADELE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W CLARKE AVE STE 1030
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1857
Mailing Address - Country:US
Mailing Address - Phone:302-742-9434
Mailing Address - Fax:
Practice Address - Street 1:21 W CLARKE AVE STE 1030
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1857
Practice Address - Country:US
Practice Address - Phone:302-742-9434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0010634363LP0808X
CANPF13746363LW0102X, 363LP0808X
DELH-0010288363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA517433Medicare UPIN