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General NPI Number Information
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NPI Number | 1407015068
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Entity Type | Individual
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Provider Name | KLESAHRA DAVIS LVN
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Gender | Female
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Dates
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Enumeration Date | 06/08/2008
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Last Update Date | 06/08/2008
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Provider Practice Location Address
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Address Line | 475 E ORANGE GROVE AVE L
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City | BURBANK
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State | CA
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Zip | 91501-2811
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Country | US
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Telephone | 818-298-3268
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Fax |
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Provider Business Mailing Address
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Address Line | 263 W OLIVE AVE 247
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City | BURBANK
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State | CA
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Zip | 91502-1825
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Country | US
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Telephone | 818-298-3268
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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 | VN140059
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License Number State | CA
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