Provider Demographics
NPI:1902387897
Name:DAVIS, WENDY G
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:G
Last Name:DAVIS
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 1:1504 GLEN WILLOW CV
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2846
Mailing Address - Country:US
Mailing Address - Phone:512-779-9642
Mailing Address - Fax:
Practice Address - Street 1:1504 GLEN WILLOW CV
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2846
Practice Address - Country:US
Practice Address - Phone:512-779-9642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651898163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse