MEDICARE: MRS. VICTORIA LYNN 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	164W00000X	Licensed Practical Nurse	4703096455	MI

General Provider Information

NPI Number	:	1679718597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA LYNN DAVIS LPN

Provider Business Mailing Address
First Line	:	9732 MESKILL RD
Second Line	:
City	:	COLUMBUS
State	:	MI
Zip	:	48063-1708
Country	:	US
Telephone Number	:	810-305-2544
Fax Number	:	810-305-2544

Provider Business Practice Location Address
First Line	:	9732 MESKILL RD
Second Line	:
City	:	COLUMBUS
State	:	MI
Zip	:	48063
Country	:	US
Telephone Number	:	810-305-2544
Fax Number	:	810-305-2544

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

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	09/18/2015

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