MEDICARE: AMBER DAVIS RN BSN

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	163WS0200X	School Registered Nurse	3909283	OH

General Provider Information

NPI Number	:	1760851331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER DAVIS RN BSN

Provider Business Mailing Address
First Line	:	5620 BROOK POINT RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43611-1406
Country	:	US
Telephone Number	:	419-514-6487
Fax Number	:

Provider Business Practice Location Address
First Line	:	5620 BROOK POINT RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43611-1406
Country	:	US
Telephone Number	:	419-514-6487
Fax Number	:

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

Provider Enumeration Date	:	09/24/2015
Last Update Date	:	09/24/2015

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