Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | APN3489 | SC |
NPI | 1386971448 |
---|---|
Provider Name | Lisa Speach |
First Address | Greenville, SC 29601 |
Second Address | Greenville, SC 29601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2009 |
Last Update Date | 11/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APN3489 | SC LICENSE (01) | SC |