Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301099354 | MI |
N | 2084N0402X | Child Neurologist | 4301099354 | MI |
Y | 2084N0402X | Child Neurologist | MD208218 | LA |
NPI | 1134356553 |
---|---|
Provider Name | Cresha Tanara-Tulani Davis |
First Address | West Monroe, LA 71291-5332 |
Second Address | West Monroe, LA 71291-5332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2009 |
Last Update Date | 08/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134356553 | (05) | LA |