Healthcare Provider Details

I. General information

NPI: 1104155530
Provider Name (Legal Business Name): ANNA W. BOONE ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 GILMER ST
REIDSVILLE NC
27320-3809
US

IV. Provider business mailing address

233 GILMER STREET PO BOX 2899
REIDSVILLE NC
27320-1069
US

V. Phone/Fax

Practice location:
  • Phone: 336-342-6196
  • Fax: 336-349-7638
Mailing address:
  • Phone: 336-342-6196
  • Fax: 336-349-7638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5004551
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: