MEDICARE: MRS. JANE DAVIS-NEVAQUAYA LVN

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	164X00000X	Licensed Vocational Nurse	110455	TX

General Provider Information

NPI Number	:	1669946596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANE DAVIS-NEVAQUAYA LVN

Provider Business Mailing Address
First Line	:	10924 DEER CREEK DR
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-7206
Country	:	US
Telephone Number	:	817-996-3287
Fax Number	:

Provider Business Practice Location Address
First Line	:	6115 CAMP BOWIE BLVD STE 290
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76116-5500
Country	:	US
Telephone Number	:	817-831-1105
Fax Number	:

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

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	01/14/2019

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