Healthcare Provider Details

I. General information

NPI: 1790853059
Provider Name (Legal Business Name): RONALD CLINTON DAVIS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 4TH PLAIN BLVD
VANCOUVER WA
98661-3713
US

IV. Provider business mailing address

803 NE 104TH AVE
VANCOUVER WA
98664-4445
US

V. Phone/Fax

Practice location:
  • Phone: 360-696-4061
  • Fax:
Mailing address:
  • Phone: 509-953-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN00157930
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: