Provider Demographics
NPI:1881352151
Name:LEE DAVIS, LAURA LYNN (RN,PHN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LYNN
Last Name:LEE DAVIS
Suffix:
Gender:F
Credentials:RN,PHN
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:LEE-DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN,RN,PHN,PMH-BC
Mailing Address - Street 1:500 N 9TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5814
Mailing Address - Country:US
Mailing Address - Phone:209-525-5300
Mailing Address - Fax:209-558-4586
Practice Address - Street 1:500 N 9TH ST STE A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5814
Practice Address - Country:US
Practice Address - Phone:209-525-5300
Practice Address - Fax:209-558-4586
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95090801163W00000X, 163WP0808X
CA552199163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health