=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972317311
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA SIIRA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2025
-----------------------------------------------------
Last Update Date | 02/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1251 RIBAUT RD
-----------------------------------------------------
City | BEAUFORT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29902-6185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-792-3504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 705 MYSTIC DR E
-----------------------------------------------------
City | BEAUFORT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29902-6016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-200-5998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 265184
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------