Individual
MS. LASHANA JONETTE WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
319 FOLLY RD, CHARLESTON, SC 29412-2518
(843) 203-2246
(843) 203-2247
Mailing address
PO BOX 632516, CINCINNATI, OH 45263-2516
(888) 472-0043
(513) 653-4122
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1253
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0632PA
—
SC
01
—
1253
SC MEDICAL LICENSE
SC
Enumeration date
12/04/2007
Last updated
05/04/2026
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