Healthcare Provider Details

I. General information

NPI: 1487085734
Provider Name (Legal Business Name): LISA WEATHERFORD YASCAVAGE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

569 HOWLANDVILLE RD
WARRENVILLE SC
29851-3430
US

IV. Provider business mailing address

569 HOWLANDVILLE RD
WARRENVILLE SC
29851-3430
US

V. Phone/Fax

Practice location:
  • Phone: 803-663-4270
  • Fax: 803-663-4271
Mailing address:
  • Phone: 803-663-4270
  • Fax: 803-663-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR38395
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: