Provider Demographics
NPI:1538856042
Name:DAVENPORT, ERIN M (LPN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12075 OLD DAYTON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-8360
Mailing Address - Country:US
Mailing Address - Phone:937-913-4314
Mailing Address - Fax:937-870-1323
Practice Address - Street 1:5624 HECKATHORN RD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-8305
Practice Address - Country:US
Practice Address - Phone:937-913-4314
Practice Address - Fax:937-870-1323
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health