Individual
JALEN MAXELL MANOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
10 POPE AVE, HILTON HEAD, SC 29928-4719
(843) 785-7786
Mailing address
10 POPE AVE, HILTON HEAD, SC 29928-4719
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
23652
SC
363LF0000X
Family Nurse Practitioner
GAA-NP000666
GA
Other
Enumeration date
01/31/2020
Last updated
03/30/2022
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