Provider Demographics
NPI:1699004333
Name:ADDISON, TWANDA DENISE (APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:TWANDA
Middle Name:DENISE
Last Name:ADDISON
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MELSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-8363
Mailing Address - Country:US
Mailing Address - Phone:803-695-0905
Mailing Address - Fax:
Practice Address - Street 1:4010 NORTH MAIN STREET,
Practice Address - Street 2:SUITE 2 OASIS PHYSICAL MEDICINE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-786-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily