Provider Demographics
NPI:1134147564
Name:ANGLE, ANDREINA DODSON (RNC WHNP)
Entity type:Individual
Prefix:MRS
First Name:ANDREINA
Middle Name:DODSON
Last Name:ANGLE
Suffix:
Gender:F
Credentials:RNC WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 UNIVERSITY PARKWAY
Mailing Address - Street 2:SUITE 1550
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801
Mailing Address - Country:US
Mailing Address - Phone:803-649-7535
Mailing Address - Fax:803-648-8771
Practice Address - Street 1:410 UNIVERSITY PARKWAY
Practice Address - Street 2:SUITE 1550
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801
Practice Address - Country:US
Practice Address - Phone:803-649-7535
Practice Address - Fax:803-648-8771
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1103363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2278Medicaid
P20991Medicare UPIN
P209911757Medicare ID - Type Unspecified