Provider Demographics
NPI:1649921859
Name:DAVIS, NINA JAYE
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:JAYE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:JAYE
Other - Last Name:OBERLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1282 3RD ST SPC 62
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:OR
Mailing Address - Zip Code:97127-9605
Mailing Address - Country:US
Mailing Address - Phone:503-457-1963
Mailing Address - Fax:
Practice Address - Street 1:29174 SW TOWN CENTER LOOP W STE 101
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9309
Practice Address - Country:US
Practice Address - Phone:503-457-1963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician