Provider Demographics
NPI:1093817108
Name:BRIGGS, CHARLOTTE PEARL (RN)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:PEARL
Last Name:BRIGGS
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 1:105 SECOND ST.
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO DOWNS
Mailing Address - State:NM
Mailing Address - Zip Code:88346-0719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:318 ABALONE LOOP
Practice Address - Street 2:
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340-0210
Practice Address - Country:US
Practice Address - Phone:505-464-3859
Practice Address - Fax:505-464-4755
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR07575163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse