Individual
LAUREN SHULER MOTHENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1910 BLANDING ST, COLUMBIA, SC 29201-3520
(803) 256-4107
(803) 253-6676
Mailing address
1910 BLANDING ST, COLUMBIA, SC 29201-3520
(803) 256-4107
(803) 253-6676
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1461PA
—
SC
Enumeration date
07/20/2012
Last updated
04/13/2017
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