Individual
JEEVAN PAUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1021 PINNACLE POINT DR STE 200, COLUMBIA, SC 29223-5740
(803) 409-7150
Mailing address
PO BOX 23321, NEW YORK, NY 10087
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
28726
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/28/2023
Last updated
08/18/2024
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