Provider Demographics
NPI:1649927609
Name:DAVIDSON, JANNA LYNN
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:LYNN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8734 BUCKSKIN DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3402
Mailing Address - Country:US
Mailing Address - Phone:248-767-0133
Mailing Address - Fax:
Practice Address - Street 1:1685 BALDWIN AVE STE 400
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-1242
Practice Address - Country:US
Practice Address - Phone:248-767-0133
Practice Address - Fax:248-846-8723
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management