Provider Demographics
NPI:1336120476
Name:DAVIDSON, LINDA LEIGH (CNM)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEIGH
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4209
Mailing Address - Country:US
Mailing Address - Phone:970-663-0135
Mailing Address - Fax:970-461-1422
Practice Address - Street 1:1900 BOISE AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5004
Practice Address - Country:US
Practice Address - Phone:970-493-1865
Practice Address - Fax:970-493-1586
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO61438176B00000X
CO2172367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07614381Medicaid
CORXN-09936OtherMEDICAID RX
CO61438OtherRN LICENSE
COCO306185Medicare PIN
COE4033Medicare ID - Type Unspecified
CORXN-09936OtherMEDICAID RX
COS95638Medicare UPIN