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NPI Code Detail

MEDICARE: LORNA DAVIS CNM

MEDICARE: LORNA DAVIS 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
1367A00000XAdvanced Practice Midwife209-003582IL

General Provider Information

NPI Number : 1720097538
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORNA DAVIS CNM
Provider Business Mailing Address
First Line : 2600 N LAKEVIEW AVE APT 4F
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1834
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6201 ROOSEVELT RD
Second Line :
City : BERWYN
State : IL
Zip : 60402-1108
Country : US
Telephone Number : 708-386-0845
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 12/23/2019

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Directions to “ LORNA DAVIS CNM” Practice Location

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