MEDICARE: MRS. LYSA MICHELLE DEL GROSSO APRN

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	163W00000X	Registered Nurse	231581	SC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	25513	SC

General Provider Information

NPI Number	:	1578089215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYSA MICHELLE DEL GROSSO APRN

Provider Business Mailing Address
First Line	:	301 PALMETTO PARK BLVD
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-7872
Country	:	US
Telephone Number	:	803-359-3545
Fax Number	:	803-359-2111

Provider Business Practice Location Address
First Line	:	301 PALMETTO PARK BLVD
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-7872
Country	:	US
Telephone Number	:	803-359-3545
Fax Number	:

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

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	04/07/2026

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