Individual
THEODORA LACY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 E 2ND ST STE 400, ERIE, PA 16507-1577
(814) 456-8980
Mailing address
808 MICHIGAN BLVD, ERIE, PA 16505-3810
(814) 456-8980
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP034083
PA
Other
Enumeration date
10/06/2025
Last updated
10/06/2025
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