Provider Demographics
NPI:1447676432
Name:ROCKWELL, JUDITH (RN)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:ROCKWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6472
Mailing Address - Country:US
Mailing Address - Phone:843-522-1166
Mailing Address - Fax:
Practice Address - Street 1:1507 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6472
Practice Address - Country:US
Practice Address - Phone:843-522-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse