Provider Demographics
NPI:1770371866
Name:DAVIS, ENDIRA MADRE (CED-L, CED-PIC)
Entity type:Individual
Prefix:
First Name:ENDIRA
Middle Name:MADRE
Last Name:DAVIS
Suffix:
Gender:
Credentials:CED-L, CED-PIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1638 ALPINE AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-2802
Mailing Address - Country:US
Mailing Address - Phone:315-515-7769
Mailing Address - Fax:
Practice Address - Street 1:1638 ALPINE AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-2802
Practice Address - Country:US
Practice Address - Phone:315-515-7769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula