Provider Demographics
NPI:1134951825
Name:DAVIS, ELEASE
Entity type:Individual
Prefix:MRS
First Name:ELEASE
Middle Name:
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 1:1 W CENTRAL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4186
Mailing Address - Country:US
Mailing Address - Phone:863-250-5722
Mailing Address - Fax:
Practice Address - Street 1:1 W CENTRAL AVE STE 104
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4186
Practice Address - Country:US
Practice Address - Phone:863-250-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula