Wilson, Lisa Marie

Wilson, Lisa Marie is an sole proprietor health care provider with primary practice located at 809 82Nd Pkwy , Myrtle Beach SC 29572-4607. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Wilson, Lisa Marie can be contacted via phone (843) 497-5929.

Contact Information

Primary practice address
809 82Nd Pkwy Myrtle Beach SC 29572-4607
Phone: (843) 497-5929
Fax: (843) 497-6601
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 1687 South Carolina

Profile Details

NPI number 1023399896
LBN Legal business name Wilson, Lisa Marie
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 7th, 2011
Last updated Mar 20th, 2017 - about 8 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1023399896 NPPES
South Carolina MEDICAID 1249PA
South Carolina Other 1687

Popular Providers