Healthcare Provider Details

I. General information

NPI: 1275593576
Provider Name (Legal Business Name): CYNTHIA W ANDERSON ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9313 MEDICAL PLAZA DR SUITE 310
CHARLESTON SC
29406-9155
US

IV. Provider business mailing address

201 SIGMA DR STE 100
SUMMERVILLE SC
29486-7715
US

V. Phone/Fax

Practice location:
  • Phone: 843-569-1856
  • Fax: 843-569-1879
Mailing address:
  • Phone: 843-569-1856
  • Fax: 843-569-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1064
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: