Provider Information for 1508350836
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MONICA LORRAINE DAVIS LISW
Sex: Female
NPI: 1508350836
Last Updated: 2024-06-10
Certification Date: 2024-06-10
Certification Date: 2024-06-10
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1508350836 | ||||||||
| Enumeration Date | 2018-06-20 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 470 W BROAD ST # 1257 COLUMBUS, OH 43215-2759 United States Phone: 614-953-4368 | Fax:614-999-9491 | ||||||||
| Primary Practice Address | 470 W BROAD ST # 1257 COLUMBUS, OH 43215-2759 United States Phone: 614-953-4368 | Fax:614-225-0991 | ||||||||
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