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: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PROSPECT ST
MILFORD NH
03055-3724
US

IV. Provider business mailing address

65 PRINCETON DR UNIT 207
HOOKSETT NH
03106-1740
US

V. Phone/Fax

Practice location:
  • Phone: 603-673-6010
  • Fax:
Mailing address:
  • Phone: 218-591-2429
  • Fax:

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: