Provider Demographics
NPI:1083124234
Name:CHANCE, CHARLOTTE (RN, AE-C)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:CHANCE
Suffix:
Gender:F
Credentials:RN, AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JAMES R THOMPSON BLVD STE 2015
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62201-1118
Mailing Address - Country:US
Mailing Address - Phone:618-482-6959
Mailing Address - Fax:618-482-8311
Practice Address - Street 1:601 JAMES R THOMPSON BLVD STE 2015
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-1118
Practice Address - Country:US
Practice Address - Phone:618-482-6959
Practice Address - Fax:618-482-8311
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041241620163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse