Individual
ANNA M. MAYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
800 N FANT ST, ANDERSON, SC 29621-5708
(864) 512-1340
Mailing address
800 N FANT ST, ANDERSON, SC 29621-5708
(864) 512-1340
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
082051
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01292611
AMERIGROUP
SC
01
—
20092234
SELECT HEALTH
SC
05
—
478186622A
—
GA
05
—
478186622B
—
GA
05
—
AN1990
—
SC
Enumeration date
06/22/2009
Last updated
10/27/2009
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