Organization
PROVISION HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LASHONDA S TYLER NP (OWNER)
(803) 302-8205
Entity
Organization
Contact information
Practice address
1320 MAIN ST STE 300, COLUMBIA, SC 29201-3266
(803) 373-0063
Mailing address
4611 HARD SCRABBLE RD STE 178, COLUMBIA, SC 29229-8584
(803) 302-8205
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
BL015940-07-2018
SC
Other
Enumeration date
07/08/2018
Last updated
07/08/2018
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