MEDICARE: LATASCHA LEWIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	75815	SC

General Provider Information

NPI Number	:	1518840891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATASCHA LEWIS

Provider Business Mailing Address
First Line	:	1836 ELM ABODE TER
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-7716
Country	:	US
Telephone Number	:	803-629-0733
Fax Number	:

Provider Business Practice Location Address
First Line	:	1836 ELM ABODE TER
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-7716
Country	:	US
Telephone Number	:	803-629-0733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2025
Last Update Date	:	07/25/2025

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Directions to “ LATASCHA LEWIS ” Practice Location

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