Provider Demographics
NPI:1518395292
Name:MATHER, LOIS MARIE (RN)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:MARIE
Last Name:MATHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 WALT RAUCH RD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8714
Mailing Address - Country:US
Mailing Address - Phone:803-345-9350
Mailing Address - Fax:
Practice Address - Street 1:1020 DUTCH FORK RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8822
Practice Address - Country:US
Practice Address - Phone:803-732-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRN40432163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRN40432Medicaid