Basic Information
| Provider Information | |||||||||
| NPI: | 1063058154 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROTHEMICH | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 312 E SHEPARD LN | ||||||||
| Address2: | |||||||||
| City: | SUMMERVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294834200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432962618 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2375 BAKER HOSPITAL BLVD | ||||||||
| Address2: | |||||||||
| City: | N CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294058233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437442750 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2019 | ||||||||
| LastUpdateDate: | 11/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 23261 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.