Healthcare Provider Details

I. General information

NPI: 1396191375
Provider Name (Legal Business Name): REBECCA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16941 FRANZISKA CT
MACOMB MI
48044-2627
US

IV. Provider business mailing address

16941 FRANZISKA CT
MACOMB MI
48044-2627
US

V. Phone/Fax

Practice location:
  • Phone: 586-854-2852
  • Fax:
Mailing address:
  • Phone: 586-854-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: