Individual
MRS. LISA MARIE SCRUGGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
809 82ND PKWY, MYRTLE BEACH, MYRTLE BEACH, SC 29572
(843) 692-1750
Mailing address
4 PIONEER LN, MYRTLE BEACH, SC 29577-0809
(336) 978-6445
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
063793
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8050734
—
NC
Enumeration date
11/23/2005
Last updated
09/20/2012
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