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General NPI Number Information
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NPI Number | 1154738573
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Entity Type | Individual
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Provider Name | CRYSTAL DAVIS REGISTERED NURSE
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Gender | Female
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 20129 TRACEY ST
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City | DETROIT
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State | MI
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Zip | 48235-1570
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Country | US
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Telephone | 313-740-8855
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Fax |
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Provider Business Mailing Address
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Address Line | 20129 TRACEY ST
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City | DETROIT
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State | MI
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Zip | 48235-1570
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Country | US
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Telephone | 313-740-8855
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703108786
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704346742
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License Number State | MI
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