Healthcare Provider Details

I. General information

NPI: 1437393410
Provider Name (Legal Business Name): ANNEKE JANS BOGARDUS FNP-BC, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 KNOX AVE
NORTH AUGUSTA SC
29841-4010
US

IV. Provider business mailing address

1520 KNOX AVE
NORTH AUGUSTA SC
29841-4010
US

V. Phone/Fax

Practice location:
  • Phone: 803-278-4120
  • Fax: 803-649-2027
Mailing address:
  • Phone: 803-278-4120
  • Fax: 803-649-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3814
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: