Individual
LISA MARIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
809 82ND PKWY, MYRTLE BEACH, SC 29572-4607
(843) 497-5929
(843) 497-6601
Mailing address
809 82ND PKWY, MYRTLE BEACH, SC 29572-4607
(843) 692-1752
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1687
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1249PA
—
SC
01
—
1687
STATE LICENSE
SC
Enumeration date
09/07/2011
Last updated
03/20/2017
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us