Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | LM294 | CA |
NPI | 1043564800 |
---|---|
Provider Name | Mrs. Davie Madelyn Holifield |
First Address | Ventura, CA 93003-3026 |
Second Address | Ventura, CA 93003-3026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2012 |
Last Update Date | 01/11/2012 |