Provider Demographics
NPI:1003151283
Name:CHARLES, MIRLEINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MIRLEINE
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MIRLEINE
Other - Middle Name:
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11511 144TH ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1043
Mailing Address - Country:US
Mailing Address - Phone:516-444-6657
Mailing Address - Fax:718-374-3328
Practice Address - Street 1:11511 144TH ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11436-1043
Practice Address - Country:US
Practice Address - Phone:516-444-6657
Practice Address - Fax:718-374-3328
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY566697163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse