Provider Demographics
NPI:1902544562
Name:AVERY-CAMPBELL, ANTENAY (RN)
Entity Type:Individual
Prefix:
First Name:ANTENAY
Middle Name:
Last Name:AVERY-CAMPBELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 ISLAND GREEN RD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7333
Mailing Address - Country:US
Mailing Address - Phone:843-284-3560
Mailing Address - Fax:
Practice Address - Street 1:230 ISLAND GREEN RD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7333
Practice Address - Country:US
Practice Address - Phone:843-284-3560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide