MEDICARE: MS. TARA L 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

General Provider Information

NPI Number	:	1922621788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TARA L DAVIS

Provider Business Mailing Address
First Line	:	1228 HOWISON PL SW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20024-4132
Country	:	US
Telephone Number	:	202-352-1363
Fax Number	:

Provider Business Practice Location Address
First Line	:	1228 HOWISON PL SW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20024-4132
Country	:	US
Telephone Number	:	202-352-1363
Fax Number	:

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

Provider Enumeration Date	:	05/27/2020
Last Update Date	:	05/27/2020

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