Provider Demographics
NPI:1295196947
Name:CHURCHILL, LISA D (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:D
Other - Last Name:CARRAHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:9500 DORCHESTER RD STE 362
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-4304
Practice Address - Country:US
Practice Address - Phone:843-212-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3767Medicaid
SCSC79656868Medicare UPIN
SCSC79657499Medicare PIN
SCSC79658798Medicare PIN
SCSC79655277Medicare UPIN
SCSC79657522Medicare UPIN
SCSC79655282Medicare UPIN
SCSC79657126Medicare UPIN
SCSC79657555Medicare UPIN
SCNP3767Medicaid
SCSC79655281Medicare PIN
SCSC79657819Medicare UPIN
SCSC79656834Medicare UPIN
SCSC79656882Medicare UPIN
SCSC79657006Medicare UPIN