Healthcare Provider Details

I. General information

NPI: 1770419095
Provider Name (Legal Business Name): JAIDA DAVENPORT-GANS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 O ST NW
WASHINGTON DC
20057-0002
US

IV. Provider business mailing address

3700 O ST NW
WASHINGTON DC
20057-0002
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-0100
  • Fax:
Mailing address:
  • Phone: 267-746-2817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberRN793381
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: