Provider Demographics
NPI:1073250007
Name:CALDWELL, CHARLENE TELMA
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:TELMA
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SYCAMORE TRAILER PARK
Mailing Address - Street 2:
Mailing Address - City:RAVENSWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26164-5149
Mailing Address - Country:US
Mailing Address - Phone:304-373-7970
Mailing Address - Fax:
Practice Address - Street 1:6 SYCAMORE TRAILER PARK
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-5149
Practice Address - Country:US
Practice Address - Phone:304-373-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant