Provider Demographics
NPI:1952161903
Name:ANGELL, REBECCA FAYE (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:FAYE
Last Name:ANGELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5121
Mailing Address - Country:US
Mailing Address - Phone:864-906-3638
Mailing Address - Fax:
Practice Address - Street 1:890 W FARIS RD STE 510
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4286
Practice Address - Country:US
Practice Address - Phone:864-906-3638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily