Provider Demographics
NPI:1346891090
Name:DAVIS, NAUTICA NAJAA
Entity Type:Individual
Prefix:
First Name:NAUTICA
Middle Name:NAJAA
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 1:23835 METHUEN AVE APT SUITE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1855
Mailing Address - Country:US
Mailing Address - Phone:586-872-0751
Mailing Address - Fax:
Practice Address - Street 1:23835 METHUEN AVE APT SUITE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-1855
Practice Address - Country:US
Practice Address - Phone:586-872-0751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst