Provider Demographics
NPI:1639862964
Name:PROVIDENCE MIDWIFERY
Entity Type:Organization
Organization Name:PROVIDENCE MIDWIFERY
Other - Org Name:PROVIDENCE MIDWIFERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:TERESA MICHELLE
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:650-622-7069
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:540-622-7069
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMANAE VITAE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-01
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty