MEDICARE: ADELE LYNN DAVIDSON

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0040591	OH

General Provider Information

NPI Number	:	1467328716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADELE LYNN DAVIDSON

Provider Business Mailing Address
First Line	:	12213 AVALON DR
Second Line	:
City	:	GRAFTON
State	:	OH
Zip	:	44044-9527
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7265 OLD OAK BLVD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3342
Country	:	US
Telephone Number	:	440-816-5755
Fax Number	:

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

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	10/14/2025

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