Healthcare Provider Details

I. General information

NPI: 1124091657
Provider Name (Legal Business Name): JOYCE VISSAGE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457-B HWY 123 BYPASS
SENECA SC
29678
US

IV. Provider business mailing address

457-B HWY 123 BYPASS
SENECA SC
29678
US

V. Phone/Fax

Practice location:
  • Phone: 864-888-4464
  • Fax: 864-888-4462
Mailing address:
  • Phone: 864-888-4464
  • Fax: 864-888-4462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberP2224
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: