Provider Demographics
NPI:1083964241
Name:FLEMING, CHARLOTTE DAMETRA
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:DAMETRA
Last Name:FLEMING
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 1:420 LAKEPOINTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 LAKEPOINTE DRIVE
Practice Address - Street 2:
Practice Address - City:MIDDLEISLAND
Practice Address - State:NY
Practice Address - Zip Code:11967
Practice Address - Country:US
Practice Address - Phone:804-400-5487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305609-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse