Healthcare Provider Details

I. General information

NPI: 1902446149
Provider Name (Legal Business Name): MS. DAVONNA NEWBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 LAKEVIEW AVE
DAYTON OH
45417-3526
US

IV. Provider business mailing address

3317 LAKEVIEW AVE
DAYTON OH
45417-3526
US

V. Phone/Fax

Practice location:
  • Phone: 937-838-1003
  • Fax:
Mailing address:
  • Phone: 937-838-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberRN548374
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: