Individual
MS. MARQEITA WILDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COSMETOLOGLY LICENSE
Contact information
Practice address
108 COLUMBIA NORTHEAST DR, COLUMBIA, SC 29223-6433
(803) 629-1186
Mailing address
PO BOX 23581, COLUMBIA, SC 29224-3581
(803) 629-1186
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
RC56060
SC
Other
Enumeration date
10/31/2022
Last updated
10/31/2022
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