Healthcare Provider Details

I. General information

NPI: 1013056514
Provider Name (Legal Business Name): REBECCA GILLIAM WRENN MS,RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 PRESTON ST
COLUMBIA SC
29205-1632
US

IV. Provider business mailing address

2727 PRESTON ST
COLUMBIA SC
29205-1632
US

V. Phone/Fax

Practice location:
  • Phone: 803-765-1635
  • Fax:
Mailing address:
  • Phone: 803-765-1635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: