Provider Demographics
NPI:1710306915
Name:WHALEY, ANNE NGOZI (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:NGOZI
Last Name:WHALEY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:ANNE
Other - Middle Name:NGOZI
Other - Last Name:WHALEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:260 CAROLINA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7398
Mailing Address - Country:US
Mailing Address - Phone:803-240-3070
Mailing Address - Fax:
Practice Address - Street 1:260 CAROLINA RIDGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7398
Practice Address - Country:US
Practice Address - Phone:803-240-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2014-47457-46453251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health