Provider Demographics
NPI:1063023117
Name:CHARLES, DIEUNEL
Entity Type:Individual
Prefix:
First Name:DIEUNEL
Middle Name:
Last Name:CHARLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 NORTHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6305
Mailing Address - Country:US
Mailing Address - Phone:919-459-7985
Mailing Address - Fax:888-271-1477
Practice Address - Street 1:327 NORTHLANDS DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6305
Practice Address - Country:US
Practice Address - Phone:919-459-7985
Practice Address - Fax:888-271-1477
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000030827364347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker