Healthcare Provider Details

I. General information

NPI: 1144030008
Provider Name (Legal Business Name): ANNA ELIZABETH UNDERWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA BOLES

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 ROCKINGHAM RD
ROCKINGHAM NC
28379-3615
US

IV. Provider business mailing address

1601 GREENE ST
COLUMBIA SC
29208-4001
US

V. Phone/Fax

Practice location:
  • Phone: 910-562-9882
  • Fax: 910-562-9955
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5023030
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: