MEDICARE: TRESA 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
1	247200000X	Other Technician

General Provider Information

NPI Number	:	1023942752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRESA DAVIS

Provider Business Mailing Address
First Line	:	UNIT 28307
Second Line	:	MEDDAC-B BUILDING 222 ROOM 207
City	:	APO
State	:	AE
Zip	:	09112-8037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNIT 28307
Second Line	:	MEDDAC-B BUILDING 222 ROOM 207
City	:	APO
State	:	AE
Zip	:	09112-8037
Country	:	US
Telephone Number	:	314-590-2347
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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Directions to “ TRESA DAVIS ” Practice Location

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