Healthcare Provider Details

I. General information

NPI: 1972920320
Provider Name (Legal Business Name): ANITA RENEE WOOLFORD MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18765 RIVERSIDE DRIVE
VANSANT VA
24656
US

IV. Provider business mailing address

PO BOX 924
VANSANT VA
24656-0924
US

V. Phone/Fax

Practice location:
  • Phone: 276-935-2880
  • Fax: 276-935-2889
Mailing address:
  • Phone: 276-935-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024171554
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19786
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: