Provider Demographics
NPI:1700341948
Name:JOHN, ANU (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANU
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G. WERBER BRYAN PSYCHIATRIC HOSPITAL
Mailing Address - Street 2:220 FAISON DRIVE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-935-7143
Mailing Address - Fax:803-935-5321
Practice Address - Street 1:G. WERBER BRYAN PSYCHIATRIC HOSPITAL
Practice Address - Street 2:220 FAISON DRIVE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-935-7143
Practice Address - Fax:803-935-5321
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22535363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health