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General NPI Number Information
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NPI Number | 1447864673
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Entity Type | Individual
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Provider Name | EDWARD ANDERSON LPN
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Gender | Male
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 2470 MALL DR
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City | N.CHARLESTON
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State | SC
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Zip | 29406
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Country | US
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Telephone | 843-207-4727
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Fax |
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Provider Business Mailing Address
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Address Line | 2414 QUAIL HOLLOW CT
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City | CHARLESTON
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State | SC
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Zip | 29414-6028
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Country | US
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Telephone | 843-642-2898
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | P25671
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License Number State | SC
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