Provider Demographics
NPI:1932420056
Name:ORR, REBECCA M (NP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:M
Last Name:ORR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:M
Other - Last Name:MAROTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2085 HENRY TECKLENBURG DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-7710
Mailing Address - Country:US
Mailing Address - Phone:843-577-6957
Mailing Address - Fax:843-577-6523
Practice Address - Street 1:2085 HENRY TECKLENBURG BLVD.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-7710
Practice Address - Country:US
Practice Address - Phone:843-577-6957
Practice Address - Fax:843-577-6523
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4276363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA5291Medicare PIN