Healthcare Provider Details

I. General information

NPI: 1417455874
Provider Name (Legal Business Name): ZHANA LASHANTI DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10620 N COUNCIL RD APT 15
OKLAHOMA CITY OK
73162-4365
US

IV. Provider business mailing address

10620 N COUNCIL RD APT 15
OKLAHOMA CITY OK
73162-4365
US

V. Phone/Fax

Practice location:
  • Phone: 510-712-2187
  • Fax:
Mailing address:
  • Phone: 510-712-2187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: