Individual
CHARISSA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
13 CLEVELAND ST, VALLEY STREAM, NY 11580-6003
(718) 978-4999
Mailing address
618 BEACH 67TH ST, ARVERNE, NY 11692-1313
(718) 474-2026
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
239216
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
239216
LPN LICENSE
NY
Enumeration date
06/20/2012
Last updated
06/20/2012
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