MEDICARE: MRS. ARNETTA MICHELLE DAVIS LPN

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	167G00000X	Licensed Psychiatric Technician	151143	OH

General Provider Information

NPI Number	:	1588008023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ARNETTA MICHELLE DAVIS LPN

Provider Business Mailing Address
First Line	:	11901 SILMOR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-1575
Country	:	US
Telephone Number	:	216-618-5571
Fax Number	:

Provider Business Practice Location Address
First Line	:	11901 SILMOR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-1575
Country	:	US
Telephone Number	:	216-618-5571
Fax Number	:

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

Provider Enumeration Date	:	04/27/2013
Last Update Date	:	04/27/2013

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