MEDICARE: ANNE LOUISE GROGAN-HANFORD AGPCNP-BC, ACNS-BC

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	363LG0600X	Gerontology Nurse Practitioner	4337	SC

General Provider Information

NPI Number	:	1922511054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE LOUISE GROGAN-HANFORD AGPCNP-BC, ACNS-BC

Provider Business Mailing Address
First Line	:	1317 QUAIL VLY W
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1554
Country	:	US
Telephone Number	:	803-807-9197
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 QUAIL VLY W
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1554
Country	:	US
Telephone Number	:	803-807-9197
Fax Number	:

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

Provider Enumeration Date	:	11/11/2017
Last Update Date	:	03/17/2018

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