Provider Demographics
NPI:1487163648
Name:GANTT, LISA FOUTZ (LPN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:FOUTZ
Last Name:GANTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MCDANIEL AVENUE
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671
Mailing Address - Country:US
Mailing Address - Phone:864-898-5965
Mailing Address - Fax:
Practice Address - Street 1:200 MCDANIEL AVE
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2527
Practice Address - Country:US
Practice Address - Phone:864-898-5965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP44091164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse