Individual
LISA MARIE BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
5500 FRONT ST # 260, SUMMERVILLE, SC 29486-7735
(843) 376-2670
(843) 376-2790
Mailing address
PO BOX 530062, ATLANTA, GA 30353-0062
(843) 695-6071
(843) 569-5879
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
23847
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP6925
—
SC
Enumeration date
04/14/2020
Last updated
07/06/2021
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