Provider Demographics
NPI:1487934030
Name:EMMER, LISA D
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:EMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:D
Other - Last Name:ROXBURGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MN
Mailing Address - Street 1:271 BARN OWL RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29054-9075
Mailing Address - Country:US
Mailing Address - Phone:803-727-7910
Mailing Address - Fax:
Practice Address - Street 1:271 BARN OWL RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:SC
Practice Address - Zip Code:29054-9075
Practice Address - Country:US
Practice Address - Phone:803-727-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0052752163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse