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General NPI Number Information
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NPI Number | 1386941193
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Entity Type | Individual
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Provider Name | JENNIFER DAVIS MACBLANE C.N.M.
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Gender | Female
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 301 PROSPECT AVE
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City | SYRACUSE
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State | NY
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Zip | 13203-1807
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Country | US
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Telephone | 315-448-5840
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Fax |
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Provider Business Mailing Address
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Address Line | 4853 THORNWOOD DR
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City | LIVERPOOL
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State | NY
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Zip | 13088-5811
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Country | US
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Telephone | 315-569-1050
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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 | 28001429
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License Number State | NY
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