MEDICARE: LINDA LEIGH DAVIDSON CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	61438	CO
2	367A00000X	Advanced Practice Midwife	2172	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	61438	OTHER	CO	RN LICENSE

General Provider Information

NPI Number	:	1336120476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA LEIGH DAVIDSON CNM

Provider Business Mailing Address
First Line	:	1627 E 18TH ST
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-4209
Country	:	US
Telephone Number	:	970-663-0135
Fax Number	:	970-461-1422

Provider Business Practice Location Address
First Line	:	1900 BOISE AVE
Second Line	:	SUITE 240
City	:	LOVELAND
State	:	CO
Zip	:	80538-5004
Country	:	US
Telephone Number	:	970-493-1865
Fax Number	:	970-493-1586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	04/29/2011

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