Bruce Terriel Davis, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN102551 Issued in OH

Practice address

416 Cove Beach Ave
Sheffield Lake, OH 44054-1819

Phone

(216) 403-5413

Fax

(440) 332-3820

NPI assigned

Mar 10, 2007

Sex

Male

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1173484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276473600000",
    "number": "1780716274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 COVE BEACH AVE",
            "city": "SHEFFIELD LAKE",
            "state": "OH",
            "postal_code": "440541819",
            "telephone_number": "440-949-3090",
            "fax_number": "440-332-3820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 COVE BEACH AVE",
            "city": "SHEFFIELD LAKE",
            "state": "OH",
            "postal_code": "440541819",
            "telephone_number": "216-403-5413",
            "fax_number": "440-332-3820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "BRUCE",
        "middle_name": "TERRIEL",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-10",
        "last_updated": "2010-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "PN102551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "271-66-72",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rex Burns
• Keasia Cannon
• Krystile Carlton
• Iysha D Chambers
• City of Sheffield Lake
• Juanita Davis, OTR/L
• Latoya Denham
• Gregory N Dziama, O.D.
• Theodore Roger Eddy
• Peggy Ann Eppley

• Licensed Practical Nurse in Sheffield Lake, OH
• Providers in Sheffield Lake, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2010; 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.