Individual
REBECCA FULLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2001 LAUREL ST, COLUMBIA, SC 29204-1018
(803) 254-3278
(803) 255-2715
Mailing address
2001 LAUREL ST, COLUMBIA, SC 29204-1018
(803) 254-3278
(803) 255-2715
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APN2647
SC
Other
Enumeration date
07/30/2006
Last updated
07/08/2007
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