Provider Demographics
NPI:1902358542
Name:DAVENPORT, ASHLEY PATRICE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:PATRICE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21548 DOEPFER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-4629
Mailing Address - Country:US
Mailing Address - Phone:313-433-7856
Mailing Address - Fax:
Practice Address - Street 1:21548 DOEPFER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-4629
Practice Address - Country:US
Practice Address - Phone:313-433-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor