MEDICARE: MS. REBECCA GILLIAM WRENN MS,RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1013056514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA GILLIAM WRENN MS,RD

Provider Business Mailing Address
First Line	:	2727 PRESTON ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-1632
Country	:	US
Telephone Number	:	803-765-1635
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 PRESTON ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-1632
Country	:	US
Telephone Number	:	803-765-1635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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