Individual
JESSICA R DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
202 MAPLEWOOD AVE, RONCEVERTE, WV 24970-1334
(304) 647-4411
(304) 647-6552
Mailing address
202 MAPLEWOOD AVE, RONCEVERTE, WV 24970-1334
(304) 647-4411
(304) 647-6552
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
60285
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093092033
—
VA
05
—
3810021661
—
WV
Enumeration date
11/04/2011
Last updated
12/15/2011
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