Individual
JOHNNIE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3201 RUSSELL BLVD, SAINT LOUIS, MO 63104-1649
(314) 585-9541
Mailing address
3201 RUSSELL BLVD, SAINT LOUIS, MO 63104-1649
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2011021506
MO
Other
Enumeration date
10/13/2014
Last updated
10/13/2014
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