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Individual

MRS. LISA PASCAL MACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
F.N.P.

Contact information

Practice address
1483 TOBIAS GLADSON BLVD, SUITE 209, CHARLESTON, SC 29407
(843) 792-4113
Mailing address
1483 TOBIAS GLADSON BLVD, SUITE 209, CHARLESTON, SC 29407
(843) 792-9888

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
082279-23
NH
363L00000X
Nurse Practitioner
Primary
25487
SC
363LF0000X
Family Nurse Practitioner
NP95003696
CA
363LF0000X
Family Nurse Practitioner
RN2310334
MA

Other

Enumeration date
02/24/2016
Last updated
12/09/2025
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