Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | ||
Y | 176B00000X | Midwife |
NPI | 1063775302 |
---|---|
Provider Name | Ms. Joanna Lynn Davis |
First Address | Bluefield, VA 24605-9214 |
Second Address | Parkersburg, WV 26101-5150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 19/04/2019 |