Healthcare Provider Details

I. General information

NPI: 1780507160
Provider Name (Legal Business Name): REBECCA MCCALLUM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COURTENAY DR
CHARLESTON SC
29425-8911
US

IV. Provider business mailing address

550 HARBOR COVE LN APT 1600F
CHARLESTON SC
29412-3026
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-7455
  • Fax:
Mailing address:
  • Phone: 858-344-3953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number279482
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: