Healthcare Provider Details

I. General information

NPI: 1053732503
Provider Name (Legal Business Name): MARISSA ELLYN DAVIS NHCM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2014
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PRINCETON DR UNIT 204
HOOKSETT NH
03106-1738
US

IV. Provider business mailing address

60 PRINCETON DR UNIT 204
HOOKSETT NH
03106-1738
US

V. Phone/Fax

Practice location:
  • Phone: 603-217-5751
  • Fax: 603-255-7704
Mailing address:
  • Phone: 603-217-5751
  • Fax: 603-255-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1069
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: