MEDICARE: TAMICKA J DAVIS REGISTERED NURSE

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	163W00000X	Registered Nurse	4704276975	MI

General Provider Information

NPI Number	:	1245918382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMICKA J DAVIS REGISTERED NURSE

Provider Business Mailing Address
First Line	:	5024 HOWE RD
Second Line	:
City	:	WAYNE
State	:	MI
Zip	:	48184-2417
Country	:	US
Telephone Number	:	734-799-6159
Fax Number	:

Provider Business Practice Location Address
First Line	:	5024 HOWE RD
Second Line	:
City	:	WAYNE
State	:	MI
Zip	:	48184-2417
Country	:	US
Telephone Number	:	734-799-6159
Fax Number	:

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

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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