Provider Demographics
NPI:1770244329
Name:MCCLARY, LISA WHITMAN (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:WHITMAN
Last Name:MCCLARY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505A ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5006
Mailing Address - Country:US
Mailing Address - Phone:843-763-1510
Mailing Address - Fax:
Practice Address - Street 1:505A ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5006
Practice Address - Country:US
Practice Address - Phone:843-763-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC104019163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool