Provider Demographics
NPI:1417605064
Name:DANIELS, REBECCA CLAIRE (RB)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CLAIRE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:RB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 DAVIDSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6422
Mailing Address - Country:US
Mailing Address - Phone:404-805-8639
Mailing Address - Fax:
Practice Address - Street 1:2070 NORTHBROOK BLVD STE A20
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9324
Practice Address - Country:US
Practice Address - Phone:843-953-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC254827163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse