=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730905696
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LONYEA TENELL DAVIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2024
-----------------------------------------------------
Last Update Date | 11/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 N BURNS ST
-----------------------------------------------------
City | MUNCIE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47303-4004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-228-7177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1408 W STIRLING DR
-----------------------------------------------------
City | MUNCIE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47304-2245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-228-7177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 373H00000X
-----------------------------------------------------
Taxonomy Name | Day Training/Habilitation Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------