Doctor Name: | LIESA A DAVIS |
NPI Number: | 1083018501 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | COA.15925-NP |
Business Practice Address: | 1050 Isaac Streets Dr Suite 137 Oregon, OH - 436163291 |
Business Phone Number: | 4196984505 |
Business Fax Number: | 4196983806 |
Mailing Address: | 7550 Lucerne Dr, Suite 405 CLEVELAND |
State: | OH |
Postal Code: | 441306588 |
Phone Number: | 4402348833 |
Fax Number: | 4402343313 |
NPI Enumeration Date: | 10/13/2014 |
NPI Last Update Date: | 12/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | COA.15925-NP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |