Provider Demographics
NPI:1124870001
Name:TICEY, DE'AUZHANAE LA'SHAE
Entity type:Individual
Prefix:
First Name:DE'AUZHANAE
Middle Name:LA'SHAE
Last Name:TICEY
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 1:5000 W OAKEY BLVD STE E1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3398
Mailing Address - Country:US
Mailing Address - Phone:702-733-2890
Mailing Address - Fax:
Practice Address - Street 1:5000 W OAKEY BLVD STE E1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3398
Practice Address - Country:US
Practice Address - Phone:702-733-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care