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General NPI Number Information
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NPI Number | 1477723062
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Entity Type | Individual
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Provider Name | EBONIEMARIE ALLENE DAVIS RN
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Gender | Female
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 4019 E 121ST ST
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City | CLEVELAND
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State | OH
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Zip | 44105-4552
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Country | US
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Telephone | 216-246-4881
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Fax |
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Provider Business Mailing Address
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Address Line | 4019 E 121ST ST
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City | CLEVELAND
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State | OH
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Zip | 44105-4552
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Country | US
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Telephone | 216-246-4881
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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 | PN. 126718
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License Number State | OH
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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 | RN.543471
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License Number State | OH
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