MEDICARE: DENISE DAVIDSON MEEKS C.N.M.

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	367A00000X	Advanced Practice Midwife	4704187704	MI

General Provider Information

NPI Number	:	1346337003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE DAVIDSON MEEKS C.N.M.

Provider Business Mailing Address
First Line	:	1990 RED SCHOOL RD
Second Line	:
City	:	BRUTUS
State	:	MI
Zip	:	49716-9708
Country	:	US
Telephone Number	:	231-539-8303
Fax Number	:

Provider Business Practice Location Address
First Line	:	2810 CHARLEVOIX AVE
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8421
Country	:	US
Telephone Number	:	231-487-0970
Fax Number	:	231-487-0979

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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