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Individual

CHERISSE YOLANDA DAVENPORT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
601 LEFTWICH ST, GRETNA, VA 24557-2506
(434) 509-5636
Mailing address
601 LEFTWICH ST, GRETNA, VA 24557-2506
(434) 509-5636

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
T60216245
VA

Other

Enumeration date
09/14/2019
Last updated
09/14/2019
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