Provider Demographics
NPI:1154915148
Name:SIMPSON, ANNA MICHELLE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MICHELLE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MICHELLE
Other - Last Name:GRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-6119
Mailing Address - Country:US
Mailing Address - Phone:864-361-2977
Mailing Address - Fax:
Practice Address - Street 1:205 IDLEWILD AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-6119
Practice Address - Country:US
Practice Address - Phone:864-361-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide