Provider Demographics
NPI:1861221277
Name:DAVIS, TERRIE LAWANDA
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:LAWANDA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 TERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63120-2020
Mailing Address - Country:US
Mailing Address - Phone:314-765-5869
Mailing Address - Fax:
Practice Address - Street 1:11551 HEREFORDSHIRE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-3534
Practice Address - Country:US
Practice Address - Phone:314-869-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider