Provider Demographics
NPI:1518727643
Name:DAVIS, TENIESHA
Entity Type:Individual
Prefix:
First Name:TENIESHA
Middle Name:
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 1:664 MARKLE AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-3023
Mailing Address - Country:US
Mailing Address - Phone:248-310-7421
Mailing Address - Fax:248-972-8670
Practice Address - Street 1:664 MARKLE AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-3023
Practice Address - Country:US
Practice Address - Phone:248-310-7421
Practice Address - Fax:248-972-8670
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8764293374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide