Basic Information
| Provider Information | |||||||||
| NPI: | 1245317122 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASAN | ||||||||
| FirstName: | LOIS | ||||||||
| MiddleName: | CHATMON | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN PNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 CHASEWOOD CT | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292032402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034342300 | ||||||||
| FaxNumber: | 8032542611 | ||||||||
| Practice Location | |||||||||
| Address1: | 1924 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292012412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034342300 | ||||||||
| FaxNumber: | 8032542611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 1005 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.