Basic Information
| Provider Information | |||||||||
| NPI: | 1386971448 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPEACH | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 ST. FRANCIS DRIVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642338063 | ||||||||
| FaxNumber: | 8642332438 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 ST. FRANCIS DRIVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642338063 | ||||||||
| FaxNumber: | 8642332438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2009 | ||||||||
| LastUpdateDate: | 11/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC0200X | APN3489 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | APN3489 | 01 | SC | SC LICENSE | OTHER |