Provider Demographics
NPI:1447504907
Name:DAVENPORT, ERICA L (LPN)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:L
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 1:123 ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WALBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43465-1428
Mailing Address - Country:US
Mailing Address - Phone:419-514-7480
Mailing Address - Fax:
Practice Address - Street 1:123 ELMWOOD RD
Practice Address - Street 2:
Practice Address - City:WALBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43465-1428
Practice Address - Country:US
Practice Address - Phone:419-514-7480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150688164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH150688OtherOHIO BOARD OF NURSING