Provider Demographics
NPI:1003867789
Name:HASELDEN, LISA SHERMAN (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SHERMAN
Last Name:HASELDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:SHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:950 W FARIS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4255
Mailing Address - Country:US
Mailing Address - Phone:864-271-3444
Mailing Address - Fax:864-255-7877
Practice Address - Street 1:950 W FARIS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4255
Practice Address - Country:US
Practice Address - Phone:864-271-3444
Practice Address - Fax:864-255-7877
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1105363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant