Provider Demographics
NPI:1467791335
Name:MACE, ANITA GRAVES (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:GRAVES
Last Name:MACE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 N RICHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-1416
Mailing Address - Country:US
Mailing Address - Phone:843-752-7117
Mailing Address - Fax:843-752-2722
Practice Address - Street 1:602 N RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1416
Practice Address - Country:US
Practice Address - Phone:843-752-7117
Practice Address - Fax:843-752-2722
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRN54263163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse