Etheridge, Lisa Fanning

Etheridge, Lisa Fanning is an individual health care provider with primary practice located at 1175 Cook Rd Ste 320 , Orangeburg SC 29118-8247. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Etheridge, Lisa Fanning can be contacted via phone (803) 395-3960.

Contact Information

Primary practice address
1175 Cook Rd Ste 320 Orangeburg SC 29118-8247
Phone: (803) 395-3960
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 20081 South Carolina

Profile Details

NPI number 1245784669
LBN Legal business name Etheridge, Lisa Fanning
Credentials FNP/APRN
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 15th, 2016
Last updated Jul 21st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245784669 NPPES
Other 7389 MEDICARE GROUP PTAN

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