Healthcare Provider Details

I. General information

NPI: 1336549435
Provider Name (Legal Business Name): REBECCA BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 CEDAR SPRINGS RD
SPARTANBURG SC
29302-4628
US

IV. Provider business mailing address

314 FISHER LAKE RD
LYMAN SC
29365-9245
US

V. Phone/Fax

Practice location:
  • Phone: 864-577-7675
  • Fax: 864-577-7629
Mailing address:
  • Phone: 864-607-1964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number217358
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: