Provider Demographics
NPI:1770033540
Name:OGLESBY, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SPRUCE STREET
Mailing Address - Street 2:141 TWIN LAKES ROAD
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341
Mailing Address - Country:US
Mailing Address - Phone:864-206-2249
Mailing Address - Fax:
Practice Address - Street 1:301 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-3252
Practice Address - Country:US
Practice Address - Phone:864-206-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP41998164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse