Provider Demographics
NPI:1275141327
Name:STOLLBERG, ANNE MUKULU (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MUKULU
Last Name:STOLLBERG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29624-2012
Mailing Address - Country:US
Mailing Address - Phone:864-224-0822
Mailing Address - Fax:864-261-8130
Practice Address - Street 1:1100 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29624-2012
Practice Address - Country:US
Practice Address - Phone:864-224-0822
Practice Address - Fax:864-261-8130
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty