Provider Demographics
NPI:1750736765
Name:ANDERSON, PAULA (RN)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 SUNVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-9027
Mailing Address - Country:US
Mailing Address - Phone:803-351-5693
Mailing Address - Fax:
Practice Address - Street 1:146 SUNVIEW RD
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-9027
Practice Address - Country:US
Practice Address - Phone:803-351-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC59443163WS0200X, 251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No251300000XAgenciesLocal Education Agency (LEA)