Healthcare Provider Details

I. General information

NPI: 1447782990
Provider Name (Legal Business Name): MICHAELA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 WAR ADMIRAL DR
STAFFORD TX
77477-6332
US

IV. Provider business mailing address

2410 WAR ADMIRAL DR
STAFFORD TX
77477-6332
US

V. Phone/Fax

Practice location:
  • Phone: 832-498-0329
  • Fax:
Mailing address:
  • Phone: 832-498-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: