MEDICARE: ANNE ELISSA D'AVIS TM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175M00000X	Lay Midwife

General Provider Information

NPI Number	:	1376813907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE ELISSA D'AVIS TM

Provider Business Mailing Address
First Line	:	5309 ASPEN DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-6018
Country	:	US
Telephone Number	:	405-245-4440
Fax Number	:	918-401-9135

Provider Business Practice Location Address
First Line	:	5309 ASPEN DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-6018
Country	:	US
Telephone Number	:	405-245-4440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	01/27/2025

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