Provider Demographics
NPI:1487349494
Name:DAVIS, NATASHA RENE (RN)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:RENE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:SHIMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1014 ROBERTA DR
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-2915
Mailing Address - Country:US
Mailing Address - Phone:618-201-3917
Mailing Address - Fax:
Practice Address - Street 1:1014 ROBERTA DR
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-2915
Practice Address - Country:US
Practice Address - Phone:618-201-3917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041312202163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management