Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 1069 | NH |
NPI | 1053732503 |
---|---|
Provider Name | Marissa Ellyn Davis |
First Address | Hooksett, NH 03106-1740 |
Second Address | Milford, NH 03055-3724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2014 |
Last Update Date | 23/09/2020 |