MEDICARE: ERIC 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	374U00000X	Home Health Aide	20151276029	NV

General Provider Information

NPI Number	:	1770960122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC DAVIS

Provider Business Mailing Address
First Line	:	2150 N TENAYA WAY
Second Line	:	1048
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0402
Country	:	US
Telephone Number	:	702-822-0584
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 N TENAYA WAY
Second Line	:	1048
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0402
Country	:	US
Telephone Number	:	702-822-0584
Fax Number	:

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

Provider Enumeration Date	:	05/05/2015
Last Update Date	:	03/19/2016

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Directions to “ ERIC DAVIS ” Practice Location

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