Individual
REBECCA ULRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
100 E WOOD ST, SUITE 301, SPARTANBURG, SC 29303-3004
(864) 560-7070
(864) 560-7073
Mailing address
PO BOX 2168, SPARTANBURG, SC 29304-2168
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1245
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0563PA
—
SC
Enumeration date
09/14/2007
Last updated
12/14/2007
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