Provider Demographics
NPI:1578765558
Name:MILLER, LISA B (PHD, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:B
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD, FNP-BC
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:B
Other - Last Name:DUGGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, FNP-BC
Mailing Address - Street 1:326 AVENDELL DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-7606
Mailing Address - Country:US
Mailing Address - Phone:864-305-7505
Mailing Address - Fax:
Practice Address - Street 1:3930 GRANDVIEW DR STE B
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-3163
Practice Address - Country:US
Practice Address - Phone:864-301-6156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily