MEDICARE: MRS. MARY BONNER DAVIS NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	23352	SC

General Provider Information

NPI Number	:	1548880743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY BONNER DAVIS NP-C

Provider Business Mailing Address
First Line	:	317 SAINT FRANCIS DR STE 220
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-3976
Country	:	US
Telephone Number	:	864-255-1901
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 SAINT FRANCIS DR STE 220
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-3976
Country	:	US
Telephone Number	:	864-255-1901
Fax Number	:	844-318-9058

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2020
Last Update Date	:	08/07/2020

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