Individual
MRS. TYESHA ROCHELLE WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3616 KELFORD DR, COLUMBIA, SC 29209-4329
(803) 521-2848
Mailing address
3616 KELFORD DR, COLUMBIA, SC 29209-4329
(803) 521-2848
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
50188
SC
Other
Enumeration date
06/01/2023
Last updated
06/01/2023
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