Individual
MAL VERNE ODEAN INNISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, APRN, ACNP-AG
Contact information
Practice address
109 BEE ST, CHARLESTON, SC 29401-5703
(843) 577-5011
Mailing address
112 LONG NEEDLE LN, SUMMERVILLE, SC 29485-4943
(843) 437-6495
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
27119
SC
363LA2100X
Acute Care Nurse Practitioner
27119
SC
363LC0200X
Critical Care Medicine Nurse Practitioner
27119
SC
Other
Enumeration date
04/12/2023
Last updated
04/18/2023
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