Healthcare Provider Details

I. General information

NPI: 1104525344
Provider Name (Legal Business Name): LAQUESSA YULINDA DOZIER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 SCOTSMAN RD STE 27
COLUMBIA SC
29223-1812
US

IV. Provider business mailing address

310 WATER HICKORY WAY
COLUMBIA SC
29229-7553
US

V. Phone/Fax

Practice location:
  • Phone: 843-992-2923
  • Fax:
Mailing address:
  • Phone: 843-992-2923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number237188
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number237188
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number237188
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number237188
License Number StateSC
# 5
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number237188
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: