Healthcare Provider Details

I. General information

NPI: 1679265409
Provider Name (Legal Business Name): JENNIFER GREEN RATHBURN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 COKESBURY RD
GREENWOOD SC
29649-9299
US

IV. Provider business mailing address

247 WINDTREE RD
GREENWOOD SC
29649-9244
US

V. Phone/Fax

Practice location:
  • Phone: 864-992-8835
  • Fax:
Mailing address:
  • Phone: 864-992-8835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number103640
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: