Individual
MS. LA TONYA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, FNP-BC, NP-C
Contact information
Practice address
6439 GARNERS FERRY RD, COLUMBIA, SC 29209-1638
(803) 776-4000
Mailing address
504 WILKINSON LN, COLUMBIA, SC 29229-6811
(803) 225-5176
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
206993
SC
363LF0000X
Family Nurse Practitioner
Primary
19664
SC
Other
Enumeration date
10/26/2010
Last updated
08/20/2015
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