Healthcare Provider Details

I. General information

NPI: 1982020970
Provider Name (Legal Business Name): LISA MARIE MASKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CHARLESTON CENTER DR
CHARLESTON SC
29401-1162
US

IV. Provider business mailing address

3 CHARLESTON CENTER DR
CHARLESTON SC
29401-1162
US

V. Phone/Fax

Practice location:
  • Phone: 843-214-0032
  • Fax: 843-579-4660
Mailing address:
  • Phone: 843-214-0032
  • Fax: 843-579-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number104523
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: