Individual
LISA M. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
800 E CHEVES ST STE 200, FLORENCE, SC 29506-2651
(843) 662-1502
(843) 678-3611
Mailing address
PO BOX 3239, FLORENCE, SC 29502-3239
(843) 777-7098
(843) 777-7102
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
21595
SC
Other
Enumeration date
01/25/2018
Last updated
02/24/2021
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