Basic Information
| Provider Information | |||||||||
| NPI: | 1275749988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | JAN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | RN MSN CNM CERTIFIED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 STADIUM MALL DRIVE | ||||||||
| Address2: | |||||||||
| City: | WEST LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479072052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654961927 | ||||||||
| FaxNumber: | 7654961227 | ||||||||
| Practice Location | |||||||||
| Address1: | 1544 WEST US 421 | ||||||||
| Address2: | |||||||||
| City: | DELPHI | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655643016 | ||||||||
| FaxNumber: | 7655642608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | 72000023A | IN | Y | Other Service Providers | Midwife |
No ID Information.