Provider Demographics
NPI:1558338459
Name:LINDER, ANITA G
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:G
Last Name:LINDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ALPINE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:COLA
Mailing Address - State:SC
Mailing Address - Zip Code:29223
Mailing Address - Country:US
Mailing Address - Phone:803-779-3548
Mailing Address - Fax:803-779-7055
Practice Address - Street 1:125 ALPINE CIRCLE
Practice Address - Street 2:
Practice Address - City:COLA
Practice Address - State:SC
Practice Address - Zip Code:29223
Practice Address - Country:US
Practice Address - Phone:803-779-3548
Practice Address - Fax:803-779-7055
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27075363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0500Medicaid
SCNP0500Medicaid