Individual
KEONA CHANTEL DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
31 SIBLEY ST STE A31E, HAMMOND, IN 46320-1725
(219) 802-8800
(219) 802-8801
Mailing address
31 SIBLEY ST STE A31E, HAMMOND, IN 46320-1725
(219) 802-8800
(219) 802-8801
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71010690A
IN
Other
Enumeration date
12/11/2020
Last updated
04/21/2021
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