Provider Demographics
NPI:1093131005
Name:REPIK, PAUL A (RN)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:REPIK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 21ST AVE N
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-7400
Mailing Address - Country:US
Mailing Address - Phone:843-448-8407
Mailing Address - Fax:843-448-7499
Practice Address - Street 1:700 21ST AVE N
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-7400
Practice Address - Country:US
Practice Address - Phone:843-448-8407
Practice Address - Fax:843-448-7499
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC60116163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health