Healthcare Provider Details

I. General information

NPI: 1518360486
Provider Name (Legal Business Name): LAURA WILKERSON HISER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 EISENHOWER DR
SAVANNAH GA
31406-3901
US

IV. Provider business mailing address

150 SCRANTON CONNECTOR
BRUNSWICK GA
31525-0540
US

V. Phone/Fax

Practice location:
  • Phone: 912-356-2155
  • Fax: 912-353-3195
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN084002
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: