Healthcare Provider Details

I. General information

NPI: 1336857382
Provider Name (Legal Business Name): CHARLOTTE DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLOTTE FRAZEE

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 NE 130TH AVE
VANCOUVER WA
98682-7989
US

IV. Provider business mailing address

2909 NE 130TH AVE
VANCOUVER WA
98682-7989
US

V. Phone/Fax

Practice location:
  • Phone: 714-421-0226
  • Fax:
Mailing address:
  • Phone: 714-421-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number202100801RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number95086405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: