Provider Demographics
NPI:1881032761
Name:SOUTHERLAND, ANITA LANIER (RN)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:LANIER
Last Name:SOUTHERLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ANITA
Other - Middle Name:LANIER
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:4104 SURLES CT STE 11
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8239
Mailing Address - Country:US
Mailing Address - Phone:919-941-1911
Mailing Address - Fax:
Practice Address - Street 1:4104 SURLES CT STE 11
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8239
Practice Address - Country:US
Practice Address - Phone:919-941-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC109510163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care