Provider Demographics
NPI:1518162494
Name:DAVIS, DEBORAH LEES (RN)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LEES
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-0485
Mailing Address - Country:US
Mailing Address - Phone:707-580-7849
Mailing Address - Fax:
Practice Address - Street 1:1679 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4151
Practice Address - Country:US
Practice Address - Phone:707-803-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
CAA4785151163WA2000X, 163WH0200X, 163WP0200X
CA426360163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No171M00000XOther Service ProvidersCase Manager/Care Coordinator