Provider Demographics
NPI:1851653091
Name:LERSTANG, MARY ALYSON NIJEM (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY ALYSON
Middle Name:NIJEM
Last Name:LERSTANG
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:9 HAWTHORNE PARK CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3194
Mailing Address - Country:US
Mailing Address - Phone:864-603-5600
Mailing Address - Fax:864-603-5601
Practice Address - Street 1:312 HARRISON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7133
Practice Address - Country:US
Practice Address - Phone:864-603-5600
Practice Address - Fax:864-603-5601
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
GARN155655363L00000X
SC21011207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner