Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 20936 | SC |
N | 2081P2900X | Pain Medicine | 20936 | SC |
NPI | 1245217322 |
---|---|
Provider Name | Rebecca Elayne Holdren |
First Address | Greenville, SC 29615-4536 |
Second Address | Greenville, SC 29605-5622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 18/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G89733 | (02) | SC |