Provider Demographics
NPI:1659563237
Name:DAVIS, PAULA JO (LM)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JO
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21810 RAVEN TREE CT
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-3621
Mailing Address - Country:US
Mailing Address - Phone:832-723-8752
Mailing Address - Fax:936-756-8348
Practice Address - Street 1:21810 RAVEN TREE CT
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-3621
Practice Address - Country:US
Practice Address - Phone:832-723-8752
Practice Address - Fax:936-756-8348
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96164176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife