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1235637182
LISA M. WALLACE
FLORENCE, SC
NPI
1235637182
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: SC 21595)
Enumeration Date
2018-01-25
Last Update Date
2021-02-24
Business Address
LISA M. WALLACE FNP
800 E CHEVES ST STE 200
FLORENCE, SC 29506-2651
Phone number: 843-662-1502
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Mailing Address
LISA M. WALLACE FNP
PO BOX 3239
FLORENCE, SC 29502-3239
Phone number: 843-777-7098
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