Healthcare Provider Details

I. General information

NPI: 1619393873
Provider Name (Legal Business Name): MS. CIERA MICHELLE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N TONTI ST
NEW ORLEANS LA
70119-3598
US

IV. Provider business mailing address

1200 LURLINE DR
JEFFERSON LA
70121-2127
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-9211
  • Fax: 504-324-4731
Mailing address:
  • Phone: 504-251-0154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14457
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: