Healthcare Provider Details

I. General information

NPI: 1790104479
Provider Name (Legal Business Name): JESSICA DAVIS CPM NHCM CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 06/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 BOW ST
EXETER NH
03833-2828
US

IV. Provider business mailing address

14 BOW ST
EXETER NH
03833-2828
US

V. Phone/Fax

Practice location:
  • Phone: 603-923-1739
  • Fax: 603-583-5194
Mailing address:
  • Phone: 603-923-1739
  • Fax: 603-583-5194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1050
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: