MEDICARE: EFFIE BEALAUSA DAVIS

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	376K00000X	Nurse's Aide	401896930916	OH

General Provider Information

NPI Number	:	1922669209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EFFIE BEALAUSA DAVIS

Provider Business Mailing Address
First Line	:	2539 HAMILTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43211-1354
Country	:	US
Telephone Number	:	614-424-0058
Fax Number	:

Provider Business Practice Location Address
First Line	:	2539 HAMILTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43211-1354
Country	:	US
Telephone Number	:	614-424-0058
Fax Number	:

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

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	06/26/2019

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Directions to “ EFFIE BEALAUSA DAVIS ” Practice Location

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