Provider Demographics
NPI:1376803569
Name:DAVIS, CLAUDETTE SUE
Entity Type:Individual
Prefix:MS
First Name:CLAUDETTE
Middle Name:SUE
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 1:3474 DROMEDARY WAY
Mailing Address - Street 2:#2303
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-3016
Mailing Address - Country:US
Mailing Address - Phone:702-582-1316
Mailing Address - Fax:
Practice Address - Street 1:3474 DROMEDARY WAY
Practice Address - Street 2:#2303
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-3016
Practice Address - Country:US
Practice Address - Phone:702-582-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner