Provider Demographics
NPI:1548679996
Name:MIXTER, ANN R (RN)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:R
Last Name:MIXTER
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 1:2731 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-3900
Mailing Address - Country:US
Mailing Address - Phone:843-745-7126
Mailing Address - Fax:843-529-3914
Practice Address - Street 1:2731 GORDON ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-3900
Practice Address - Country:US
Practice Address - Phone:843-745-7126
Practice Address - Fax:843-529-3914
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC91797163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC163WS0200XMedicaid