Provider Demographics
NPI:1366016396
Name:DAVIS, MARIAH PATRICE
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:PATRICE
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 1:813 CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-5681
Mailing Address - Country:US
Mailing Address - Phone:337-577-7266
Mailing Address - Fax:
Practice Address - Street 1:6590 SHADY LANE
Practice Address - Street 2:
Practice Address - City:SCURRY
Practice Address - State:TX
Practice Address - Zip Code:75158
Practice Address - Country:US
Practice Address - Phone:469-721-6621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA210583163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse