Healthcare Provider Details

I. General information

NPI: 1750100541
Provider Name (Legal Business Name): REBEKAH LILAH ROBERTS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HAMPTON ST
COLUMBIA SC
29204-1002
US

IV. Provider business mailing address

2000 HAMPTON ST
COLUMBIA SC
29204-1002
US

V. Phone/Fax

Practice location:
  • Phone: 803-873-7975
  • Fax: 803-576-2880
Mailing address:
  • Phone: 803-873-7975
  • Fax: 803-576-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number230855
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: