Provider Demographics
NPI:1063058154
Name:ROTHEMICH, REBECCA (APRN-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ROTHEMICH
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E SHEPARD LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-4200
Mailing Address - Country:US
Mailing Address - Phone:843-296-2618
Mailing Address - Fax:
Practice Address - Street 1:2375 BAKER HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8233
Practice Address - Country:US
Practice Address - Phone:843-744-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-23
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23261363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care