MEDICARE: MS. SARAH LISA FRIERSON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	03898	SC

General Provider Information

NPI Number	:	1215166111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH LISA FRIERSON FNP

Provider Business Mailing Address
First Line	:	1278 MOORE ST
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-4601
Country	:	US
Telephone Number	:	843-389-7251
Fax Number	:

Provider Business Practice Location Address
First Line	:	1278 MOORE ST
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-4601
Country	:	US
Telephone Number	:	843-389-7251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2009
Last Update Date	:	07/15/2009

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