Individual
MRS. JAMIE LEA DISHAROON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 GATEWAY CORPORATE BLVD, COLUMBIA, SC 29203-9611
(803) 865-4500
Mailing address
120 GATEWAY CORPORATE BLVD, COLUMBIA, SC 29203-9611
(803) 865-4500
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
17864
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17864
APRN
SC
01
—
RN107046
NURSING
SC
Enumeration date
03/05/2012
Last updated
10/01/2012
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