Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN.CNP.0027404 | OH |
NPI | 1003573544 |
---|---|
Provider Name | Kaitlin Davis |
First Address | Berlin Heights, OH 44814-9565 |
Second Address | Lorain, OH 44053-4152 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2021 |
Last Update Date | 18/11/2021 |