Individual
MRS. LEE YOUNG BASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
615 WESLEY DR, SUITE 200, CHARLESTON, SC 29407-7204
(843) 571-6880
(843) 571-1387
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
19552
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP3503
—
SC
Enumeration date
07/13/2015
Last updated
10/29/2020
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