Individual
CHARITY LEE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5110 AVALON COURT DR, MELVILLE, NY 11747-8203
(703) 898-1685
Mailing address
176 LOEFFLER ST, BRENTWOOD, NY 11717-5807
(516) 943-3613
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
328195-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000
—
NY
Enumeration date
07/13/2019
Last updated
07/13/2019
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