Healthcare Provider Details

I. General information

NPI: 1366631806
Provider Name (Legal Business Name): LATRICE JOSEPHINE DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5621 VIEW POINTE DR APT C
CINCINNATI OH
45213-2634
US

IV. Provider business mailing address

5621 VIEW POINTE DR APT C
CINCINNATI OH
45213-2634
US

V. Phone/Fax

Practice location:
  • Phone: 513-546-2587
  • Fax:
Mailing address:
  • Phone: 513-546-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number309816
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: