Individual
MS. CHARLENE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
183 LAKEVIEW AVE., SYR, NY 13204
(315) 474-0601
Mailing address
183 LAKEVIEW AVE., SYR, NY 13204
(315) 474-0601
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
169191-1
NY
Other
Enumeration date
09/08/2010
Last updated
09/08/2010
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