Provider Demographics
NPI:1063775302
Name:DAVIS, JOANNA LYNN (CPM, CLS)
Entity type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:
Credentials:CPM, CLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 N BEALE RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-6915
Mailing Address - Country:US
Mailing Address - Phone:469-669-8059
Mailing Address - Fax:
Practice Address - Street 1:1930 N BEALE RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-6915
Practice Address - Country:US
Practice Address - Phone:469-669-8059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063775302Medicaid