Provider Demographics
NPI:1730497512
Name:DAVIS, WENDI LYNN (LMT)
Entity type:Individual
Prefix:
First Name:WENDI
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 MATCH POINT DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1137
Mailing Address - Country:US
Mailing Address - Phone:410-340-4216
Mailing Address - Fax:443-249-3131
Practice Address - Street 1:440 MAIN ST
Practice Address - Street 2:SUITE 112
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-4400
Practice Address - Country:US
Practice Address - Phone:410-340-4216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMO3902172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker