Healthcare Provider Details

I. General information

NPI: 1518162494
Provider Name (Legal Business Name): DEBORAH LEES DAVIS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1679 SUNSET AVE
FAIRFIELD CA
94533-4151
US

IV. Provider business mailing address

PO BOX 485
SUISUN CITY CA
94585-0485
US

V. Phone/Fax

Practice location:
  • Phone: 707-803-5007
  • Fax:
Mailing address:
  • Phone: 707-580-7849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberA4785151
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberA4785151
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number426360
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberA4785151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: