Healthcare Provider Details

I. General information

NPI: 1205790144
Provider Name (Legal Business Name): LISA MARIE BOLAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3093 SC-14
GREER SC
29650
US

IV. Provider business mailing address

305 WIND SPRINGS WAY
GREENVILLE SC
29605
US

V. Phone/Fax

Practice location:
  • Phone: 864-720-1900
  • Fax:
Mailing address:
  • Phone: 864-720-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number236512
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: