Provider Demographics
NPI:1356821904
Name:RUMPH, PAULETTE O'NEAL
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:O'NEAL
Last Name:RUMPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 ROYAL LINKS DR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8390
Mailing Address - Country:US
Mailing Address - Phone:843-453-7560
Mailing Address - Fax:803-888-2007
Practice Address - Street 1:136-4 FORUM DR
Practice Address - Street 2:1018
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229
Practice Address - Country:US
Practice Address - Phone:803-836-8679
Practice Address - Fax:803-888-2007
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily