Healthcare Provider Details

I. General information

NPI: 1578055786
Provider Name (Legal Business Name): PATRICIA LYNNE DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAT DAVIS RN

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WESTSIDE COMMUNITY SCHOOLS 909 SOUTH 76 STREET
OMAHA NE
68114-4599
US

IV. Provider business mailing address

909 S 76TH ST
OMAHA NE
68114-4519
US

V. Phone/Fax

Practice location:
  • Phone: 402-390-2100
  • Fax: 402-390-2136
Mailing address:
  • Phone: 402-390-2100
  • Fax: 402-390-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number42073
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: