MEDICARE: TOWANNA SHANETT-LANCE ENOCH NP-C

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	363LA2200X	Adult Health Nurse Practitioner	17617	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982709069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOWANNA SHANETT-LANCE ENOCH NP-C

Provider Business Mailing Address
First Line	:	169 LAURELHURST AVE
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-3825
Country	:	US
Telephone Number	:	803-733-5969
Fax Number	:	803-753-5591

Provider Business Practice Location Address
First Line	:	1228 HARDEN ST STE C
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-1800
Country	:	US
Telephone Number	:	803-748-1184
Fax Number	:	803-748-1185

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	06/23/2022

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