Healthcare Provider Details

I. General information

NPI: 1083675409
Provider Name (Legal Business Name): LINDA SUE DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10296 HAYESVILLE RD
KINGSTON OH
45644-9657
US

IV. Provider business mailing address

10296 HAYESVILLE RD
KINGSTON OH
45644-9657
US

V. Phone/Fax

Practice location:
  • Phone: 740-642-5118
  • Fax:
Mailing address:
  • Phone: 740-642-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 271460
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: