NPI 1902562101

Marisha S Davis

Practitioner Prevention Professional Brown Deer, WI

Practice location

Address: 5007 W Fairy Chasm CT, Brown Deer, WI 53223-1406
Phone: (414) 595-0890

Registered specialties

Prevention Professional Primary

Other Service Providers Taxonomy 405300000X Licence 3568832 (WI)

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Registry record

NPI: 1902562101
Entity type: Individual
Sex (as registered): Female
NPI issued: 11 Nov 2021
Record last updated: 11 Nov 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.