Provider Demographics
NPI:1083850085
Name:RIDDLE, LISA OXLEY (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:OXLEY
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:OXLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:125 COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4812
Mailing Address - Country:US
Mailing Address - Phone:864-655-4000
Mailing Address - Fax:
Practice Address - Street 1:125 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4812
Practice Address - Country:US
Practice Address - Phone:864-655-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-21
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN37367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered