Provider Demographics
NPI:1417024076
Name:DAVIS, ROSANNA MAY (LM, CPM)
Entity Type:Individual
Prefix:
First Name:ROSANNA
Middle Name:MAY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E CREEK DR # 8
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3662
Mailing Address - Country:US
Mailing Address - Phone:650-289-0809
Mailing Address - Fax:
Practice Address - Street 1:120 E CREEK DR # 8
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3662
Practice Address - Country:US
Practice Address - Phone:650-289-0809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM180367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife