Provider Demographics
NPI:1144499948
Name:DAVIS, SELENA KATHERINE (RN, COHN-S)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:KATHERINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, COHN-S
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:KATHERINE
Other - Last Name:EASTERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:STE 1D03
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5674
Mailing Address - Country:US
Mailing Address - Phone:912-435-5075
Mailing Address - Fax:912-435-5009
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:STE 1D03
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5674
Practice Address - Country:US
Practice Address - Phone:912-435-5075
Practice Address - Fax:912-435-5009
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN033605163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health