Provider Demographics
NPI:1467197004
Name:WALKER, REBECCA MAZZEI (RN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MAZZEI
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 CRYSTAL PEAK DR
Mailing Address - Street 2:
Mailing Address - City:GRANITEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29829-3750
Mailing Address - Country:US
Mailing Address - Phone:803-341-7181
Mailing Address - Fax:
Practice Address - Street 1:2100 BULL STREET
Practice Address - Street 2:O-422
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2104
Practice Address - Country:US
Practice Address - Phone:803-206-6385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC247035163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC247035OtherSC LLR SBON