Provider Demographics
NPI:1073563326
Name:WEMPLE, CHARLES T (RN)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:T
Last Name:WEMPLE
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:PO BOX 1403
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-1403
Mailing Address - Country:US
Mailing Address - Phone:575-613-2098
Mailing Address - Fax:
Practice Address - Street 1:413 SIPAPU ST
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6489
Practice Address - Country:US
Practice Address - Phone:575-758-5857
Practice Address - Fax:575-758-2832
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NMRN-75869163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No174400000XOther Service ProvidersSpecialist