MEDICARE: MARILYN ANJUM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	30109	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578359014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN ANJUM

Provider Business Mailing Address
First Line	:	300 SINGLETON RIDGE RD
Second Line	:	ATTN CREDENTIALING
City	:	CONWAY
State	:	SC
Zip	:	29526-9142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 CHURCH ST STE A
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-4422
Country	:	US
Telephone Number	:	843-365-0295
Fax Number	:	843-365-0354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2025
Last Update Date	:	01/02/2026

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Directions to “ MARILYN ANJUM ” Practice Location

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