MEDICARE: JUDY REYNOLDS RABON RN,BSN,MSN,FNPC

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	363LF0000X	Family Nurse Practitioner	SC4108	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1255623674	OTHER	SC	ADVANTAGE HEALTH AND WELLNESS CENTER

General Provider Information

NPI Number	:	1255623674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY REYNOLDS RABON RN,BSN,MSN,FNPC

Provider Business Mailing Address
First Line	:	507 W PALMETTO ST
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29501-4427
Country	:	US
Telephone Number	:	843-669-1010
Fax Number	:	843-669-1054

Provider Business Practice Location Address
First Line	:	723 BROKEN BIT RD
Second Line	:
City	:	REMBERT
State	:	SC
Zip	:	29128-9628
Country	:	US
Telephone Number	:	803-432-5565
Fax Number	:

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

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	06/10/2013

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