Individual
LISA MONDO DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2728 SUNSET BLVD STE 400, WEST COLUMBIA, SC 29169-4872
(803) 744-4940
(803) 744-4938
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
23416
SC
Other
Enumeration date
11/14/2019
Last updated
07/17/2024
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