MEDICARE: GRACE REBECCA ANDERSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	278962	SC
2	133V00000X	Registered Dietitian	012676-01	NY

General Provider Information

NPI Number	:	1194544692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE REBECCA ANDERSON RN

Provider Business Mailing Address
First Line	:	8251 WINDSOR HILL BLVD APT 9303
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-8450
Country	:	US
Telephone Number	:	423-366-1863
Fax Number	:

Provider Business Practice Location Address
First Line	:	8251 WINDSOR HILL BLVD APT 9303
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-8450
Country	:	US
Telephone Number	:	423-366-1863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2024
Last Update Date	:	08/30/2025

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Directions to “ GRACE REBECCA ANDERSON RN” Practice Location

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