1962839357 NPI number — MS. LINDSEY JOANN FRITSCH DAVISON CNM, WHNP

Table of content: MS. LINDSEY JOANN FRITSCH DAVISON CNM, WHNP (NPI 1962839357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962839357 NPI number — MS. LINDSEY JOANN FRITSCH DAVISON CNM, WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVISON
Provider First Name:
LINDSEY
Provider Middle Name:
JOANN FRITSCH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNM, WHNP
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:
1962839357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 W BONITA AVE
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91767-1863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 W BONITA AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91767-1863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-392-2002
Provider Business Practice Location Address Fax Number:
909-392-2363
Provider Enumeration Date:
10/01/2013

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: 363LW0102X , with the licence number:  23745 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367A00000X , with the licence number: 2072 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com