MEDICARE: LISA B PURCELL N.P.

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	2064	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619947975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA B PURCELL N.P.

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	864-522-8603
Fax Number	:	864-797-6198

Provider Business Practice Location Address
First Line	:	100 OMNI DR STE B
Second Line	:
City	:	SENECA
State	:	SC
Zip	:	29672-9448
Country	:	US
Telephone Number	:	864-886-9250
Fax Number	:	864-886-9251

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	01/03/2024

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