Basic Information
| Provider Information | |||||||||
| NPI: | 1467874255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDERS | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2168 | ||||||||
| Address2: | |||||||||
| City: | SPARTANBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293042168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645604304 | ||||||||
| FaxNumber: | 8645604413 | ||||||||
| Practice Location | |||||||||
| Address1: | 322 W SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644298029 | ||||||||
| FaxNumber: | 8644293515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2014 | ||||||||
| LastUpdateDate: | 03/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 18641 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | SC2674H888 | 01 | SC | MEDICARE PIN | OTHER | SC2674J577 | 01 | SC | MEDICARE PIN | OTHER | NP2693 | 05 | SC | MEDICAID | SC26746121 | 01 | SC | MEDICARE PIN | OTHER | SC26745019 | 01 | SC | MEDICARE PIN | OTHER | SC26746067 | 01 | SC | MEDICARE PIN | OTHER |