Provider Demographics
NPI:1598336141
Name:TROTTER, ANITA WATSON
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:WATSON
Last Name:TROTTER
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 1:210 W STONE AVE STE UL1
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-5496
Mailing Address - Country:US
Mailing Address - Phone:864-438-1144
Mailing Address - Fax:864-438-1148
Practice Address - Street 1:210 W STONE AVE STE UL1
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-5496
Practice Address - Country:US
Practice Address - Phone:864-438-1144
Practice Address - Fax:864-438-1148
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC84-4827983Medicaid