Individual
MRS. LISA B COLASURDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1220 PARKSIDE ACORN DR, INMAN, SC 29349-8344
(864) 516-1783
Mailing address
1220 PARKSIDE ACORN DR, INMAN, SC 29349-8344
(864) 516-1783
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN 875
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GP4988
MEDICAID GROUP ID
SC
05
—
NP0491
—
SC
01
—
P00695569
RR MEDICARE PTAN
SC
Enumeration date
09/23/2005
Last updated
09/15/2025
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