Provider Demographics
NPI:1144987082
Name:RUSSELL-DAVIS, HANNAH (CPM)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:RUSSELL-DAVIS
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 FAIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5437
Mailing Address - Country:US
Mailing Address - Phone:434-996-0866
Mailing Address - Fax:
Practice Address - Street 1:425 FAIRWAY AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5437
Practice Address - Country:US
Practice Address - Phone:434-996-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-28
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000169176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife