Provider Demographics
NPI:1306594460
Name:MUNGER, REBECCA ROWELL (DNP, NP-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ROWELL
Last Name:MUNGER
Suffix:
Gender:F
Credentials:DNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1218
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-5218
Mailing Address - Country:US
Mailing Address - Phone:803-635-6461
Mailing Address - Fax:
Practice Address - Street 1:880 W MOULTRIE ST STE 200
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-2411
Practice Address - Country:US
Practice Address - Phone:803-635-6461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily