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General NPI Number Information
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NPI Number | 1417604190
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Entity Type | Individual
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Provider Name | OLIVIA LOUISE JANDL PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/03/2022
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 2863 N HIGHWAY 17
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City | MOUNT PLEASANT
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State | SC
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Zip | 29466-8962
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Country | US
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Telephone | 843-606-3911
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Fax |
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Provider Business Mailing Address
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Address Line | 247 HERITAGE CIR
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-3017
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Country | US
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Telephone | 978-804-4014
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4314
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License Number State | SC
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