Provider Demographics
NPI:1235415613
Name:DAVIS, NAKIYA MONIQUE
Entity Type:Individual
Prefix:
First Name:NAKIYA
Middle Name:MONIQUE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10320 ALL SEASONS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-1536
Mailing Address - Country:US
Mailing Address - Phone:702-860-1664
Mailing Address - Fax:
Practice Address - Street 1:10320 ALL SEASONS ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-1536
Practice Address - Country:US
Practice Address - Phone:702-860-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-29
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator