Individual
MRS. JACQUELINE JUNE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2912 SPRINGBORO RD, MORAINE, OH 45439-1674
(937) 297-8999
(937) 277-8618
Mailing address
6544 RIVERBEND DR, DAYTON, OH 45415-2676
(937) 416-3400
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
COA. 12542-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000742437
ANTHEM BCBS OHIO
OH
05
—
0054352
—
OH
01
—
421534506182
CARESROUCE OHIO
OH
Enumeration date
09/26/2011
Last updated
12/05/2012
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