Individual
MARY LISA BRANTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
517 MOYE BLVD, GREENVILLE, NC 27834-2849
(252) 744-2335
(252) 744-5035
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
172458
NC
363L00000X
Nurse Practitioner
Primary
5005507
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7006440
—
NC
Enumeration date
03/28/2012
Last updated
02/02/2026
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