Healthcare Provider Details

I. General information

NPI: 1609754837
Provider Name (Legal Business Name): LISA M MCNEILL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA M BRANHAM

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TAYLOR AT MARION STREET
COLUMBIA SC
29220-0001
US

IV. Provider business mailing address

796 BIG BEAVER CREEK RD
SWANSEA SC
29160-9369
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-5010
  • Fax:
Mailing address:
  • Phone: 803-378-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number284172
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: