Healthcare Provider Details

I. General information

NPI: 1316137342
Provider Name (Legal Business Name): JENNIFER ALYSSA DAVIS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ALYSSA DAVIS D.O.

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET MLC 7015
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET MLC 7015
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4266
  • Fax: 513-636-3549
Mailing address:
  • Phone: 513-636-4266
  • Fax: 513-636-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number34.009949
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: