Healthcare Provider Details

I. General information

NPI: 1386611424
Provider Name (Legal Business Name): STEPHANIE L SCHALLER PPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE L VILLANO NP

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 LANDMARK DR STE 300
COLUMBIA SC
29204-4034
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-1470
  • Fax: 803-898-1471
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-293-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2812
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: