Provider Demographics
NPI:1679265409
Name:RATHBURN, JENNIFER GREEN (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GREEN
Last Name:RATHBURN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 WINDTREE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-9244
Mailing Address - Country:US
Mailing Address - Phone:864-992-8835
Mailing Address - Fax:
Practice Address - Street 1:1816 COKESBURY RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-9299
Practice Address - Country:US
Practice Address - Phone:864-992-8835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103640163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool