Provider Demographics
NPI:1174879720
Name:VANLANDINGHAM, ANSLEY TOLLISON (FNP-C (MSN, BSN))
Entity type:Individual
Prefix:MRS
First Name:ANSLEY
Middle Name:TOLLISON
Last Name:VANLANDINGHAM
Suffix:
Gender:F
Credentials:FNP-C (MSN, BSN)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-7211
Mailing Address - Country:US
Mailing Address - Phone:662-390-8992
Mailing Address - Fax:662-335-7933
Practice Address - Street 1:1699 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7211
Practice Address - Country:US
Practice Address - Phone:662-390-8992
Practice Address - Fax:662-335-7933
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR884042363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner