Provider Demographics
NPI:1871836007
Name:WALKER-DAVIS, ANDREA DENISE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DENISE
Last Name:WALKER-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 1:1516 E TROPICANA AVE STE 154
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-8316
Mailing Address - Country:US
Mailing Address - Phone:702-268-8109
Mailing Address - Fax:702-268-8009
Practice Address - Street 1:1516 E TROPICANA AVE STE 154
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-8316
Practice Address - Country:US
Practice Address - Phone:702-268-8109
Practice Address - Fax:702-268-8009
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-06
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner