Healthcare Provider Details

I. General information

NPI: 1013630979
Provider Name (Legal Business Name): ALICIA MARIE RODMAN DNP, FNP-C, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5133 RIVERS AVE
NORTH CHARLESTON SC
29406-6338
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-1786
  • Fax:
Mailing address:
  • Phone: 888-472-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-306493
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30563
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: