Healthcare Provider Details

I. General information

NPI: 1023521879
Provider Name (Legal Business Name): REBECCA CORBETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 NORTH ST
BAMBERG SC
29003-1317
US

IV. Provider business mailing address

PO BOX 188
NEESES SC
29107-0188
US

V. Phone/Fax

Practice location:
  • Phone: 803-378-2715
  • Fax:
Mailing address:
  • Phone: 803-378-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN.230557
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: