MEDICARE: MRS. CHARLOTTE TATUM 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	163WA2000X	Administrator Registered Nurse	639096	TX
2	163WC1500X	Community Health Registered Nurse	639096	TX
3	163WI0600X	Infection Control Registered Nurse	639096	TX
4	163WP0808X	Psychiatric/Mental Health Registered Nurse	639096	TX
5	163WH0200X	Home Health Registered Nurse	639096	TX
6	163W00000X	Registered Nurse	639096	TX
7	163WN1003X	Nutrition Support Registered Nurse	639096	TX
8	163WX0106X	Occupational Health Registered Nurse	639096	TX
9	373H00000X	Day Training/Habilitation Specialist	639096	TX
10	171M00000X	Case Manager/Care Coordinator	639096	TX
11	174H00000X	Health Educator	639096	TX
12	225C00000X	Rehabilitation Counselor	639096	TX

General Provider Information

NPI Number	:	1881980712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLOTTE TATUM DAVIS RN

Provider Business Mailing Address
First Line	:	21810 BURBANK HL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-1677
Country	:	US
Telephone Number	:	210-698-1836
Fax Number	:	210-698-1836

Provider Business Practice Location Address
First Line	:	21810 BURBANK HL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-1677
Country	:	US
Telephone Number	:	210-698-1836
Fax Number	:	210-698-1836

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

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	06/30/2011

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