Provider Demographics
NPI:1447020086
Name:DAVIS, MELISSA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6416 NORTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-5928
Mailing Address - Country:US
Mailing Address - Phone:515-779-9886
Mailing Address - Fax:
Practice Address - Street 1:6416 NORTHWEST DR
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-5928
Practice Address - Country:US
Practice Address - Phone:515-779-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085202163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant