Individual
FONDA MAE WILKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
115 BLARNEY DR, COLUMBIA, SC 29223-6291
(803) 419-9091
(803) 419-9199
Mailing address
115 BLARNEY DR, COLUMBIA, SC 29223-6291
(803) 419-9091
(803) 419-9199
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
2964
SC
363LC0200X
Critical Care Medicine Nurse Practitioner
2964
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP1257
—
SC
01
—
P00889659
MEDICARE RAILROAD
SC
Enumeration date
07/24/2006
Last updated
03/02/2012
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