Individual
MRS. LISA A DUBOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, BC
Contact information
Practice address
200 PATEWOOD DR, SUITE A300, GREENVILLE, SC 29615-3593
(864) 454-5530
(864) 241-9246
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN 1598
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598
ADVANCED PRACTICE LICENSE
SC
05
—
NP1903
—
SC
Enumeration date
01/05/2007
Last updated
06/03/2021
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