MEDICARE: CHINIQUA MARIE DAVIS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	414217	OH

General Provider Information

NPI Number	:	1285297788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHINIQUA MARIE DAVIS RN

Provider Business Mailing Address
First Line	:	1446 LANDER RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-1608
Country	:	US
Telephone Number	:	216-978-8390
Fax Number	:

Provider Business Practice Location Address
First Line	:	1446 LANDER RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-1608
Country	:	US
Telephone Number	:	216-978-8390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2019
Last Update Date	:	04/19/2019

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