Healthcare Provider Details

I. General information

NPI: 1205963915
Provider Name (Legal Business Name): REBECCA S. DAMIN RN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 BROAD ST
DURHAM NC
27705-4141
US

IV. Provider business mailing address

7316 WADE LOOP
CEDAR GROVE NC
27231-9700
US

V. Phone/Fax

Practice location:
  • Phone: 919-220-4224
  • Fax: 919-220-7390
Mailing address:
  • Phone: 336-562-2685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number165551
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: