MEDICARE: MRS. LISA MARIE SHINDLER

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	163W00000X	Registered Nurse	93539	SC

General Provider Information

NPI Number	:	1881355089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIE SHINDLER

Provider Business Mailing Address
First Line	:	8800 DORCHESTER RD UNIT 4002
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7344
Country	:	US
Telephone Number	:	843-364-2256
Fax Number	:

Provider Business Practice Location Address
First Line	:	8800 DORCHESTER RD UNIT 4002
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7344
Country	:	US
Telephone Number	:	843-364-2256
Fax Number	:

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

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	01/10/2022

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