Healthcare Provider Details

I. General information

NPI: 1619087616
Provider Name (Legal Business Name): REBECCA M ROWAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 HARRINGTON ST
NEWBERRY SC
29108-2817
US

IV. Provider business mailing address

1539 HARRINGTON ST
NEWBERRY SC
29108-2817
US

V. Phone/Fax

Practice location:
  • Phone: 803-944-7801
  • Fax:
Mailing address:
  • Phone: 803-944-7801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2959
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: