Individual
MRS. LISA DIANE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
310 SW 16TH ST, CHEHALIS, WA 98532-3809
(360) 807-7200
Mailing address
139 SUNNYSIDE DR, CENTRALIA, WA 98531-1727
(360) 736-3983
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP00036338
WA
Other
Enumeration date
09/17/2020
Last updated
09/17/2020
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