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General NPI Number Information
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NPI Number | 1063320455
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Entity Type | Individual
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Provider Name | LAVERNE WILDS RN
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Gender | Female
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Dates
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Enumeration Date | 08/28/2026
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Last Update Date | 08/28/2026
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Provider Practice Location Address
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Address Line | 1341 N CASHUA DR
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City | FLORENCE
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State | SC
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Zip | 29501-6939
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Country | US
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Telephone | 855-694-8288
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Fax |
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Provider Business Mailing Address
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Address Line | 924 CHANCELLOR DR
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City | HARTSVILLE
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State | SC
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Zip | 29550-5205
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | 226984
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License Number State | SC
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