Individual
LATONIA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
7535 PELL ST APT B, COLUMBIA, SC 29209-4035
(803) 237-5722
Mailing address
7535 PELL ST APT B, COLUMBIA, SC 29209-4035
(803) 237-5722
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
171131E
SC
Other
Enumeration date
07/07/2016
Last updated
07/07/2016
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