MEDICARE: MRS. RAINA LEE ROCKWELL BSN, RN

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	163WS0200X	School Registered Nurse	250769	SC

General Provider Information

NPI Number	:	1275287336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RAINA LEE ROCKWELL BSN, RN

Provider Business Mailing Address
First Line	:	148 T AND H DR
Second Line	:
City	:	PICKENS
State	:	SC
Zip	:	29671-9358
Country	:	US
Telephone Number	:	864-517-7701
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 WOODSIDE AVE
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-4221
Country	:	US
Telephone Number	:	864-565-8004
Fax Number	:	864-383-6293

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

Provider Enumeration Date	:	02/08/2022
Last Update Date	:	02/08/2022

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