Provider Demographics
NPI:1366774135
Name:DAVIS, LISA KAREN (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAREN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-0711
Mailing Address - Country:US
Mailing Address - Phone:866-867-8585
Mailing Address - Fax:866-867-8585
Practice Address - Street 1:514 LAUREL LN
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-2166
Practice Address - Country:US
Practice Address - Phone:866-867-8585
Practice Address - Fax:866-867-8585
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN552739163WH0200X, 163WX0106X, 163W00000X, 163WC0400X, 163WC1500X
DEL1-0033856163WX0106X, 163W00000X, 163WC0400X, 163WC1500X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health