Provider Demographics
NPI:1699348573
Name:RAMBO, PETER JR (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:RAMBO
Suffix:JR
Gender:M
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 KUNKLE RD
Mailing Address - Street 2:
Mailing Address - City:SILVERSTREET
Mailing Address - State:SC
Mailing Address - Zip Code:29145-9216
Mailing Address - Country:US
Mailing Address - Phone:803-944-6458
Mailing Address - Fax:
Practice Address - Street 1:637 BELLAMY AVE UNIT C
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-6472
Practice Address - Country:US
Practice Address - Phone:800-965-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25160363LA2200X, 363LG0600X, 363LP2300X
NC5015957363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology