Provider Demographics
NPI:1831973866
Name:ANDERSON, MARTHA ROSETTA (RN, BNS, CCM)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ROSETTA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN, BNS, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2731 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-3900
Mailing Address - Country:US
Mailing Address - Phone:843-745-2025
Mailing Address - Fax:843-745-2182
Practice Address - Street 1:2731 GORDON ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-3900
Practice Address - Country:US
Practice Address - Phone:843-745-2025
Practice Address - Fax:843-745-2182
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC273442163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool