Healthcare Provider Details

I. General information

NPI: 1427664432
Provider Name (Legal Business Name): BRITTANY LYNN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ERIN CT
HILLSBORO OH
45133-8591
US

IV. Provider business mailing address

PO BOX 823
HILLSBORO OH
45133-0823
US

V. Phone/Fax

Practice location:
  • Phone: 937-393-9720
  • Fax: 937-393-9703
Mailing address:
  • Phone: 937-393-4562
  • Fax: 937-393-2056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number174517
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: