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General NPI Number Information
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NPI Number | 1164421806
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Entity Type | Individual
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Provider Name | DAVA J DERRICK CNP
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Gender | Female
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 02/14/2014
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Provider Practice Location Address
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Address Line | 1250 NATIONAL RD SUITE 400
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City | CLAYTON
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State | OH
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Zip | 45315-9505
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Country | US
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Telephone | 937-836-5165
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Fax | 937-836-6709
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Provider Business Mailing Address
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Address Line | 1250 NATIONAL RD SUITE 400
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City | CLAYTON
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State | OH
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Zip | 45315-9505
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Country | US
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Telephone | 937-836-5165
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Fax | 937-836-6709
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP06888
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License Number State | OH
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