Healthcare Provider Details

I. General information

NPI: 1790185643
Provider Name (Legal Business Name): TY-RENAI DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 11/16/2024
Certification Date: 11/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3316 JAMAICA PRINCESS PL UNIT 2
NORTH LAS VEGAS NV
89084-3339
US

IV. Provider business mailing address

3316 JAMAICA PRINCESS PL UNIT 2
NORTH LAS VEGAS NV
89084-3339
US

V. Phone/Fax

Practice location:
  • Phone: 702-900-8001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: