Provider Demographics
NPI:1982259644
Name:DAVIS, TYRONELL MONIQUE (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:TYRONELL
Middle Name:MONIQUE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4066 GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-1622
Mailing Address - Country:US
Mailing Address - Phone:504-266-6601
Mailing Address - Fax:
Practice Address - Street 1:4066 GIBSON ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-1622
Practice Address - Country:US
Practice Address - Phone:504-266-6601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA386069224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist