Provider Demographics
NPI:1932372067
Name:PIERSOL, LINDSAY W (FNP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:W
Last Name:PIERSOL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:600 N. WHEELER AVENUE
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-0630
Mailing Address - Country:US
Mailing Address - Phone:803-364-4852
Mailing Address - Fax:803-364-2014
Practice Address - Street 1:600 N. WHEELER AVENUE
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-0630
Practice Address - Country:US
Practice Address - Phone:803-364-4852
Practice Address - Fax:803-364-2014
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA36843093OtherMEDICARE PTAN
SCNP1434Medicaid