Provider Demographics
NPI:1225542194
Name:TYLER, LASHONDA S
Entity Type:Individual
Prefix:
First Name:LASHONDA
Middle Name:S
Last Name:TYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 TWO NOTCH RD APT 133
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4395
Mailing Address - Country:US
Mailing Address - Phone:803-308-4143
Mailing Address - Fax:
Practice Address - Street 1:10120 TWO NOTCH RD APT 133
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4395
Practice Address - Country:US
Practice Address - Phone:803-308-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21476363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily