Wellington Hervey Davis Jr., RN WISCONSIN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

65286030 Issued in WI

Practice address

721 Buttenhoff Rd
Chippewa Falls, WI 54729

Phone

(715) 723-5426

NPI assigned

May 30, 2008

Last updated

May 30, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212105600000",
    "number": "1225296700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 BUTTENHOFF RD",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "54729",
            "telephone_number": "715-723-5426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 BUTTENHOFF RD",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "54729",
            "telephone_number": "715-723-5426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "WELLINGTON",
        "middle_name": "HERVEY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "RN WISCONSIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-30",
        "last_updated": "2008-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "65286030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35017200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Chippewa Falls, WI
• Providers in Chippewa Falls, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.