Provider Demographics
NPI:1023454725
Name:DAVIS, JESSICA ANN (PHD, RN, CCRN, IBCLC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD, RN, CCRN, IBCLC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 SHADY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-9032
Mailing Address - Country:US
Mailing Address - Phone:602-616-5312
Mailing Address - Fax:
Practice Address - Street 1:313 SHADY GLEN DR
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-9032
Practice Address - Country:US
Practice Address - Phone:602-616-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN627615163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant