MEDICARE: WHITNEY JANEEN DAVIS MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1033727193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY JANEEN DAVIS MSW

Provider Business Mailing Address
First Line	:	9267 TONKAWA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-5509
Country	:	US
Telephone Number	:	702-587-3236
Fax Number	:

Provider Business Practice Location Address
First Line	:	2580 N RANCHO DR STE 106
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3361
Country	:	US
Telephone Number	:	702-329-9174
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2020
Last Update Date	:	07/15/2020

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