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General NPI Number Information
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NPI Number | 1922511054
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Entity Type | Individual
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Provider Name | ANNE LOUISE GROGAN-HANFORD AGPCNP-BC, ACNS-BC
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Gender | Female
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Dates
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Enumeration Date | 11/11/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1317 QUAIL VLY W
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City | COLUMBIA
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State | SC
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Zip | 29212-1554
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Country | US
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Telephone | 803-807-9197
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Fax |
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Provider Business Mailing Address
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Address Line | 1317 QUAIL VLY W
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City | COLUMBIA
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State | SC
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Zip | 29212-1554
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Country | US
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Telephone | 803-807-9197
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 4337
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License Number State | SC
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