Provider Demographics
NPI:1295120822
Name:JAMES, LISA G (CRNA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:JAMES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CHESTNUT HILL PL
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6662
Mailing Address - Country:US
Mailing Address - Phone:864-430-2479
Mailing Address - Fax:
Practice Address - Street 1:2 CHESTNUT HILL PL
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6662
Practice Address - Country:US
Practice Address - Phone:864-430-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19547367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered