Individual
MRS. REBECCA E BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
207 COMMERCE AVE, CHESTERFIELD, SC 29709
(843) 623-2229
(843) 623-2553
Mailing address
PO BOX 471, CHESTERFIELD, SC 29709
(843) 623-2229
(843) 623-2553
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
56924
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405127
—
SC
Enumeration date
09/07/2006
Last updated
07/08/2007
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