Provider Demographics
NPI:1154634269
Name:DEGAUGH, CHARLES (LPN)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:DEGAUGH
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SUMMER ST
Mailing Address - Street 2:APT. 7K
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2229
Mailing Address - Country:US
Mailing Address - Phone:585-576-3577
Mailing Address - Fax:
Practice Address - Street 1:66 SUMMER ST
Practice Address - Street 2:APT. 7K
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2229
Practice Address - Country:US
Practice Address - Phone:585-576-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301695164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse