MEDICARE: JENNIFER TERESA MICHELLE DAVIDSON CPM, LM

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	0129-000152	VA

General Provider Information

NPI Number	:	1568095206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER TERESA MICHELLE DAVIDSON CPM, LM

Provider Business Mailing Address
First Line	:	7760 MAIN ST
Second Line	:
City	:	MIDDLETOWN
State	:	VA
Zip	:	22645-9500
Country	:	US
Telephone Number	:	760-208-5860
Fax Number	:	540-301-3572

Provider Business Practice Location Address
First Line	:	7760 MAIN ST
Second Line	:
City	:	MIDDLETOWN
State	:	VA
Zip	:	22645-9500
Country	:	US
Telephone Number	:	760-208-5860
Fax Number	:

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

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	03/02/2026

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