Healthcare Provider Details

I. General information

NPI: 1386298024
Provider Name (Legal Business Name): MONICA S SIRES NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 W 2ND ST
SWANSEA SC
29160-8665
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-568-2000
  • Fax: 803-568-4190
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22984
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: