Basic Information
| Provider Information | |||||||||
| NPI: | 1588815534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | NEWBERRY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CNM | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | NEWBERRY | ||||||||
| OtherFirstName: | MARY | ||||||||
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| OtherCredential: | CNM | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9 COMMERCIAL BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949496118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158425000 | ||||||||
| FaxNumber: | 4158425163 | ||||||||
| Practice Location | |||||||||
| Address1: | 1260 S ELISEO DR | ||||||||
| Address2: | FLOOR 2 | ||||||||
| City: | GREENBRAE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949042009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159241214 | ||||||||
| FaxNumber: | 4159241375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2008 | ||||||||
| LastUpdateDate: | 11/15/2018 | ||||||||
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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 | 367A00000X | NMW1505 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | NMW1505 | 01 | CA | MEDICAL LICENSE | OTHER |