Provider Demographics
NPI:1902405368
Name:WANZER, LATOYA
Entity Type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:
Last Name:WANZER
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 1:19 MANIGAULT CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8827
Mailing Address - Country:US
Mailing Address - Phone:843-616-4310
Mailing Address - Fax:843-799-2350
Practice Address - Street 1:19 MANIGAULT CT
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8827
Practice Address - Country:US
Practice Address - Phone:843-616-4310
Practice Address - Fax:843-799-2350
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency