Healthcare Provider Details

I. General information

NPI: 1366774135
Provider Name (Legal Business Name): LISA KAREN DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 LAUREL LN
NEWARK DE
19702-2166
US

IV. Provider business mailing address

PO BOX 711
BEAR DE
19701-0711
US

V. Phone/Fax

Practice location:
  • Phone: 866-867-8585
  • Fax: 866-867-8585
Mailing address:
  • Phone: 866-867-8585
  • Fax: 866-867-8585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN552739
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberL1-0033856
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN552739
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0033856
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN552739
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberL1-0033856
License Number StateDE
# 7
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN552739
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberL1-0033856
License Number StateDE
# 9
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN552739
License Number StatePA
# 10
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberL1-0033856
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: