Healthcare Provider Details

I. General information

NPI: 1003392556
Provider Name (Legal Business Name): NATASHA RENEE DAVIS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 NORTHCUTT PL
DAYTON OH
45414-3840
US

IV. Provider business mailing address

138 WHITMORE AVE
DAYTON OH
45417-1434
US

V. Phone/Fax

Practice location:
  • Phone: 937-496-2020
  • Fax:
Mailing address:
  • Phone: 937-304-5643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.005523
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number1333-66
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: