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NPI Code Detail

MEDICARE: JAISA MICHELLE DAVIS

MEDICARE: JAISA MICHELLE 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
1253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1912711698
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAISA MICHELLE DAVIS
Provider Business Mailing Address
First Line : 1111 PENNSYLVANIA AVE
Second Line :
City : LINCOLN
State : NE
Zip : 68521-8922
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7562 UPTON GREY LN
Second Line :
City : LINCOLN
State : NE
Zip : 68516-5694
Country : US
Telephone Number : 402-904-7433
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2025
Last Update Date : 02/04/2025

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Directions to “ JAISA MICHELLE DAVIS ” Practice Location

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