Provider Demographics
NPI:1033552039
Name:WILEY, DANA TIMMERMAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:TIMMERMAN
Last Name:WILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 E GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-4271
Mailing Address - Country:US
Mailing Address - Phone:864-366-5924
Mailing Address - Fax:864-366-4011
Practice Address - Street 1:815 E GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-4271
Practice Address - Country:US
Practice Address - Phone:864-366-5924
Practice Address - Fax:864-366-4011
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP27982164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse