Healthcare Provider Details

I. General information

NPI: 1659882942
Provider Name (Legal Business Name): LINDA K DAVIS BSN, RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 N LAKE DR RM W2039
MILWAUKEE WI
53211-4508
US

IV. Provider business mailing address

2323 N LAKE DR RM W2039
MILWAUKEE WI
53211-4508
US

V. Phone/Fax

Practice location:
  • Phone: 414-585-1060
  • Fax:
Mailing address:
  • Phone: 414-585-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number158664
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: