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General NPI Number Information
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NPI Number | 1053732503
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Entity Type | Individual
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Provider Name | MARISSA ELLYN DAVIS NHCM, CPM
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Gender | Female
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Dates
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Enumeration Date | 01/01/2014
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 4 PROSPECT ST
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City | MILFORD
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State | NH
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Zip | 03055-3724
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Country | US
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Telephone | 603-673-6010
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Fax |
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Provider Business Mailing Address
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Address Line | 65 PRINCETON DR UNIT 207
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City | HOOKSETT
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State | NH
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Zip | 03106-1740
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Country | US
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Telephone | 218-591-2429
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 1069
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License Number State | NH
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