Provider Demographics
NPI:1013750777
Name:TRAVIS, TANIESHA CHANTRESE
Entity type:Individual
Prefix:
First Name:TANIESHA
Middle Name:CHANTRESE
Last Name:TRAVIS
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 1:2881 S VALLEY VIEW BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0171
Mailing Address - Country:US
Mailing Address - Phone:702-253-1031
Mailing Address - Fax:702-253-9474
Practice Address - Street 1:2881 S VALLEY VIEW BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0171
Practice Address - Country:US
Practice Address - Phone:702-253-1031
Practice Address - Fax:702-253-9474
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747A0650X, 376J00000X
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker