MEDICARE: SUSAN MEGHAN DAVIS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	444151	OH
2	164W00000X	Licensed Practical Nurse	130337	OH
3	163W00000X	Registered Nurse	RN444151	OH

General Provider Information

NPI Number	:	1437692274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MEGHAN DAVIS RN

Provider Business Mailing Address
First Line	:	925 KEYNOTE CIRCLE SUITE #300
Second Line	:
City	:	BROOKLYN HTS
State	:	OH
Zip	:	44131
Country	:	US
Telephone Number	:	216-931-1400
Fax Number	:	216-694-4181

Provider Business Practice Location Address
First Line	:	925 KEYNOTE CIRCLE SUITE #300
Second Line	:
City	:	BROOKLYN HTS
State	:	OH
Zip	:	44131
Country	:	US
Telephone Number	:	216-931-1400
Fax Number	:	216-694-4181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2016
Last Update Date	:	08/14/2019

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