Healthcare Provider Details

I. General information

NPI: 1215874896
Provider Name (Legal Business Name): GREG ISENBERGER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3265 CEDAR CIRCLE RD
LANCASTER SC
29720-9700
US

IV. Provider business mailing address

3265 CEDAR CIRCLE RD
LANCASTER SC
29720-9700
US

V. Phone/Fax

Practice location:
  • Phone: 704-254-0089
  • Fax:
Mailing address:
  • Phone: 704-254-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number242079
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: