Provider Demographics
NPI:1013056514
Name:WRENN, REBECCA GILLIAM (MS,RD)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:GILLIAM
Last Name:WRENN
Suffix:
Gender:F
Credentials:MS,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1632
Mailing Address - Country:US
Mailing Address - Phone:803-765-1635
Mailing Address - Fax:
Practice Address - Street 1:2727 PRESTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1632
Practice Address - Country:US
Practice Address - Phone:803-765-1635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered