Provider Demographics
NPI:1972920320
Name:WOOLFORD, ANITA RENEE (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:RENEE
Last Name:WOOLFORD
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 924
Mailing Address - Street 2:
Mailing Address - City:VANSANT
Mailing Address - State:VA
Mailing Address - Zip Code:24656-0924
Mailing Address - Country:US
Mailing Address - Phone:276-935-2880
Mailing Address - Fax:
Practice Address - Street 1:18765 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:VANSANT
Practice Address - State:VA
Practice Address - Zip Code:24656
Practice Address - Country:US
Practice Address - Phone:276-935-2880
Practice Address - Fax:276-935-2889
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171554363LF0000X
TN19786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVE692B288Medicare PIN
TN103I508605Medicare PIN