Individual
NICHOLE D DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4TH &INNER LOOP, FORT IRWIN, CA 92310
(760) 380-3185
Mailing address
3102 RHINELAND DR, #B, FORT IRWIN, CA 92310-1543
(760) 386-4947
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002070702
VA
Other
Enumeration date
11/07/2006
Last updated
07/08/2007
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