Lisa M. Wallace, FNP
Nurse Practitioner, Family in Florence, SC. Individual provider (NPI-1).
NPI number1235637182
StatusActive
Last updated in NPPESFeb 24, 2021
Details
- NPI
- 1235637182
- Entity type
- Individual (NPI-1)
- Name
- Lisa M. Wallace
- Credential
- FNP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 25, 2018
- Certification date
- Feb 24, 2021
- Last updated
- Feb 24, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 21595 | SC | Yes |
Practice location
800 E Cheves St Ste 200Florence, SC 29506-2651
Phone 843-662-1502 · Fax 843-678-3611
Mailing address
Po Box 3239Florence, SC 29502-3239
Phone 843-777-7098 · Fax 843-777-7102
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