Basic Information
| Provider Information | |||||||||
| NPI: | 1891469482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | AUDRA | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1427 E MINER RD | ||||||||
| Address2: | |||||||||
| City: | MAYFIELD HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441241707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404883003 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 AKRON GENERAL AVE | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443072432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303446000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2021 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | RN.415931 | OH | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 367500000X | APRN.CRNA.0020346 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.