Provider Demographics
NPI:1063000420
Name:WEBER, TATUM REBECCA (LPN)
Entity type:Individual
Prefix:MRS
First Name:TATUM
Middle Name:REBECCA
Last Name:WEBER
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 BOARDWALK DR STE A
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-7994
Mailing Address - Country:US
Mailing Address - Phone:843-645-2770
Mailing Address - Fax:
Practice Address - Street 1:124 BOARDWALK DR STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-7994
Practice Address - Country:US
Practice Address - Phone:843-645-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN133569-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse