Most Relevant Information
Provider Data
| NPI Number: | 1003400961 |
| Provider Name: | ANGELA RENAE DAVIS |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/22/2021 |
| Last Updated: | 02/22/2021 |
Provider Practice Location
234 LYNN OAK DR
LAVALETTE
WV
255358017
Practice Location Phone/Fax
| Phone: | 3046343719 |
| Fax: |
Provider Mailing Location
234 LYNN OAK DR
LAVALETTE
WV
255358017
Provider Mailing Phone/Fax
| Phone: | 3046343719 |
| Fax: |