Healthcare Provider Details

I. General information

NPI: 1619947975
Provider Name (Legal Business Name): LISA B PURCELL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MICHELLE BRIDWELL

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OMNI DR STE B
SENECA SC
29672-9448
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-886-9250
  • Fax: 864-886-9251
Mailing address:
  • Phone: 864-522-8603
  • Fax: 864-797-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2064
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: