Provider Demographics
NPI:1487339966
Name:DAVIS, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 DANDELION LN
Mailing Address - Street 2:
Mailing Address - City:AMHERSTDALE
Mailing Address - State:WV
Mailing Address - Zip Code:25607-4500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:189 DANDELION LN
Practice Address - Street 2:
Practice Address - City:AMHERSTDALE
Practice Address - State:WV
Practice Address - Zip Code:25607-4500
Practice Address - Country:US
Practice Address - Phone:304-687-5873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39106163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health