Provider Demographics
NPI:1053732503
Name:DAVIS, MARISSA ELLYN (NHCM, CPM)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ELLYN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NHCM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PRINCETON DR UNIT 207
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1740
Mailing Address - Country:US
Mailing Address - Phone:218-591-2429
Mailing Address - Fax:
Practice Address - Street 1:4 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-3724
Practice Address - Country:US
Practice Address - Phone:603-673-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-01
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1069176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife