Provider Demographics
NPI:1144580119
Name:CHARLTON-FRY, ROBIN MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:MARIE
Last Name:CHARLTON-FRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:MARIE
Other - Last Name:FRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:62401 FOOTHILL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-9113
Mailing Address - Country:US
Mailing Address - Phone:406-214-4242
Mailing Address - Fax:
Practice Address - Street 1:62401 FOOTHILL RD
Practice Address - Street 2:
Practice Address - City:SAINT IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-9113
Practice Address - Country:US
Practice Address - Phone:406-214-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPN8777164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTPN8777OtherLPN LICENSE