Healthcare Provider Details

I. General information

NPI: 1689480857
Provider Name (Legal Business Name): CHENELLE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PENNSYLVANIA AVE SE STE 210
WASHINGTON DC
20003-4344
US

IV. Provider business mailing address

1323 FARMINGDALE AVE
CAPITOL HEIGHTS MD
20743-1229
US

V. Phone/Fax

Practice location:
  • Phone: 202-282-3004
  • Fax:
Mailing address:
  • Phone: 240-304-2743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00223202
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: