Provider Demographics
NPI:1649638099
Name:DAVISON, BRIEANA (CPM LM)
Entity type:Individual
Prefix:
First Name:BRIEANA
Middle Name:
Last Name:DAVISON
Suffix:
Gender:F
Credentials:CPM LM
Other - Prefix:
Other - First Name:BRIEANA
Other - Middle Name:
Other - Last Name:DAVISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPM LM
Mailing Address - Street 1:1885 HOWARD ST N
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-4844
Mailing Address - Country:US
Mailing Address - Phone:612-367-7939
Mailing Address - Fax:651-447-7873
Practice Address - Street 1:1885 HOWARD ST N
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-4844
Practice Address - Country:US
Practice Address - Phone:951-397-6264
Practice Address - Fax:651-447-7873
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-31
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI503-49176B00000X
MN1093176B00000X
CPM22070019176B00000X
MN374J00000X
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula