Provider Demographics
NPI:1487085734
Name:YASCAVAGE, LISA WEATHERFORD (RN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:WEATHERFORD
Last Name:YASCAVAGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 HOWLANDVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29851-3430
Mailing Address - Country:US
Mailing Address - Phone:803-663-4270
Mailing Address - Fax:803-663-4271
Practice Address - Street 1:569 HOWLANDVILLE RD
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29851-3430
Practice Address - Country:US
Practice Address - Phone:803-663-4270
Practice Address - Fax:803-663-4271
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR38395163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC163WA2000XMedicaid