Provider Demographics
NPI:1083232292
Name:GHARI, CHARLISSA CHINEQUE (RN)
Entity Type:Individual
Prefix:
First Name:CHARLISSA
Middle Name:CHINEQUE
Last Name:GHARI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-2002
Mailing Address - Country:US
Mailing Address - Phone:513-462-2703
Mailing Address - Fax:
Practice Address - Street 1:624 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2002
Practice Address - Country:US
Practice Address - Phone:513-462-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.402183163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice