Provider Demographics
NPI:1346482908
Name:EDWARDS-WISE, LATEKA
Entity Type:Individual
Prefix:MRS
First Name:LATEKA
Middle Name:
Last Name:EDWARDS-WISE
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 1:145 BROOKLAND CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-1416
Mailing Address - Country:US
Mailing Address - Phone:803-463-7063
Mailing Address - Fax:
Practice Address - Street 1:145 BROOKLAND CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-1416
Practice Address - Country:US
Practice Address - Phone:803-463-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-28
Last Update Date:2009-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide