Healthcare Provider Details

I. General information

NPI: 1720179492
Provider Name (Legal Business Name): LUCY ALICE DAVENPORT RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 SE ELLIS ST
PORTLAND OR
97202-5113
US

IV. Provider business mailing address

1630 SE ELLIS ST
PORTLAND OR
97202-5113
US

V. Phone/Fax

Practice location:
  • Phone: 503-233-1409
  • Fax:
Mailing address:
  • Phone: 503-233-1409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: