Healthcare Provider Details

I. General information

NPI: 1144987082
Provider Name (Legal Business Name): HANNAH RUSSELL-DAVIS CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2021
Last Update Date: 11/28/2021
Certification Date: 11/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 FAIRWAY AVE
CHARLOTTESVILLE VA
22902-5437
US

IV. Provider business mailing address

425 FAIRWAY AVE
CHARLOTTESVILLE VA
22902-5437
US

V. Phone/Fax

Practice location:
  • Phone: 434-996-0866
  • Fax:
Mailing address:
  • Phone: 434-996-0866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0129000169
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: