Provider Demographics
NPI:1831162304
Name:BRANNIGAN, LISA B (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:BRANNIGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MIDLANDS CT
Mailing Address - Street 2:STE A
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3456
Mailing Address - Country:US
Mailing Address - Phone:803-926-1515
Mailing Address - Fax:
Practice Address - Street 1:109 MIDLANDS CT
Practice Address - Street 2:STE A
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3456
Practice Address - Country:US
Practice Address - Phone:803-926-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2441363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0490Medicaid
P12034Medicare UPIN
SCNP0490Medicaid