Provider Demographics
NPI:1033458534
Name:DAVIS, MEGHAN VISNICK (CNMW)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:VISNICK
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNMW
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5047 N EAGLE HWY
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49670-9744
Mailing Address - Country:US
Mailing Address - Phone:734-649-6380
Mailing Address - Fax:
Practice Address - Street 1:1200 SIXTH ST
Practice Address - Street 2:STE 400
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2369
Practice Address - Country:US
Practice Address - Phone:231-392-0650
Practice Address - Fax:231-392-0665
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704273686363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704273686OtherLICENSE