Provider Demographics
NPI:1720805849
Name:DAVIDSON MEADOWS, JENNIFER (RWP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DAVIDSON MEADOWS
Suffix:
Gender:F
Credentials:RWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WHITE BEAR TRL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-1214
Mailing Address - Country:US
Mailing Address - Phone:505-577-0437
Mailing Address - Fax:
Practice Address - Street 1:1600 LENA ST STE C10
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4339
Practice Address - Country:US
Practice Address - Phone:505-577-0437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach