1336120476 NPI number — LINDA LEIGH DAVIDSON CNM

Table of content: LINDA LEIGH DAVIDSON CNM (NPI 1336120476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336120476 NPI number — LINDA LEIGH DAVIDSON CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIDSON
Provider First Name:
LINDA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336120476
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 BOISE AVE
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
LOVELAND
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80538-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-493-1865
Provider Business Practice Location Address Fax Number:
970-493-1586
Provider Enumeration Date:
11/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X , with the licence number:  61438 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: 2172 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07614381 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: RXN-09936 . This is a "MEDICAID RX" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 61438 . This is a "RN LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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