MEDICARE: MRS. PATRICIA DIAN DAVIS

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	103TR0400X	Rehabilitation Psychologist

General Provider Information

NPI Number	:	1083912166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA DIAN DAVIS

Provider Business Mailing Address
First Line	:	4773 MADRID RIDGE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-3682
Country	:	US
Telephone Number	:	702-656-9890
Fax Number	:	702-656-9152

Provider Business Practice Location Address
First Line	:	4773 MADRID RIDGE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-3682
Country	:	US
Telephone Number	:	702-656-9890
Fax Number	:	702-656-9152

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

Provider Enumeration Date	:	03/14/2011
Last Update Date	:	03/14/2011

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