Provider Demographics
NPI:1578890133
Name:DAVIS, JENNIFER BENNETT (ICCE-CD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BENNETT
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ICCE-CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-0338
Mailing Address - Country:US
Mailing Address - Phone:910-787-3693
Mailing Address - Fax:910-326-2828
Practice Address - Street 1:403 S GLANCY ST
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-9656
Practice Address - Country:US
Practice Address - Phone:910-787-3693
Practice Address - Fax:910-326-2828
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator