Provider Demographics
NPI:1568095206
Name:DAVIDSON, JENNIFER TERESA MICHELLE (CPM, LM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TERESA MICHELLE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7760 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:VA
Mailing Address - Zip Code:22645-9500
Mailing Address - Country:US
Mailing Address - Phone:760-208-5860
Mailing Address - Fax:
Practice Address - Street 1:7760 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:VA
Practice Address - Zip Code:22645-9500
Practice Address - Country:US
Practice Address - Phone:760-208-5860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129-000152176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife