Individual
LISA LIDE BROCKINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1606 PICKFORD LN, FLORENCE, SC 29501-6492
(843) 260-7757
Mailing address
1606 PICKFORD LN, FLORENCE, SC 29501-6492
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
218452
SC
Other
Enumeration date
01/28/2018
Last updated
01/28/2018
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