Gantt, Lisa D

Gantt, Lisa D is an individual health care provider with primary practice located at 200 Patewood Dr Ste B200 , Greenville SC 29615-6321. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Gantt, Lisa D can be contacted via phone (864) 232-7338.

Contact Information

Primary practice address
200 Patewood Dr Ste B200 Greenville SC 29615-6321
Phone: (864) 232-7338
Fax: (864) 239-6645
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X A764 South Carolina

Profile Details

NPI number 1487636643
LBN Legal business name Gantt, Lisa D
Credentials Adult Nurse Practitioner (ANP)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2005
Last updated Jan 31st, 2014 - about 11 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 1487636643 NPPES
South Carolina MEDICAID PA1845
South Carolina Other 1874
South Carolina Other P01251001

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