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General NPI Number Information
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NPI Number | 1851954341
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Entity Type | Individual
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Provider Name | ALOYSIUS DE'MON DAVIS SR. LPN SKILLED CARE
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Gender | Male
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Dates
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Enumeration Date | 04/19/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 6240 NEBRASKA AVE
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City | KANSAS CITY
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State | KS
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Zip | 66102-1356
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Country | US
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Telephone | 913-963-0021
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Fax |
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Provider Business Mailing Address
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Address Line | 6240 NEBRASKA AVE
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City | KANSAS CITY
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State | KS
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Zip | 66102-1356
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Country | US
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Telephone | 913-963-0021
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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 | 24-27714-122
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License Number State | KS
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