Provider Demographics
NPI:1679109045
Name:DAVEY, NICHOL
Entity type:Individual
Prefix:
First Name:NICHOL
Middle Name:
Last Name:DAVEY
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 1:112 ULLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBY
Mailing Address - State:WI
Mailing Address - Zip Code:54667
Mailing Address - Country:US
Mailing Address - Phone:608-632-2340
Mailing Address - Fax:
Practice Address - Street 1:S2969 SEBION RD
Practice Address - Street 2:
Practice Address - City:WESTBY
Practice Address - State:WI
Practice Address - Zip Code:54667
Practice Address - Country:US
Practice Address - Phone:603-634-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider