Provider Demographics
NPI:1124836689
Name:DAVIS, SIMONE
Entity type:Individual
Prefix:
First Name:SIMONE
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 1:3001 LAKE EAST DR APT 1011
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2207
Mailing Address - Country:US
Mailing Address - Phone:888-629-3590
Mailing Address - Fax:
Practice Address - Street 1:3001 LAKE EAST DR APT B1011
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2205
Practice Address - Country:US
Practice Address - Phone:888-629-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker