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General NPI Number Information
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NPI Number | 1972886943
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Entity Type | Individual
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Provider Name | JACQUELINE JUNE DAVIS NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 2912 SPRINGBORO RD
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City | MORAINE
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State | OH
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Zip | 45439-1674
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Country | US
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Telephone | 937-297-8999
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Fax | 937-277-8618
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Provider Business Mailing Address
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Address Line | 6544 RIVERBEND DR
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City | DAYTON
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State | OH
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Zip | 45415-2676
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Country | US
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Telephone | 937-416-3400
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | COA. 12542-NP
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License Number State | OH
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