Provider Demographics
NPI:1164147179
Name:CHARLTON, VALERIE VICTORIA (FNP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:VICTORIA
Last Name:CHARLTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37520 MULLIGAN DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-8081
Mailing Address - Country:US
Mailing Address - Phone:626-327-9633
Mailing Address - Fax:
Practice Address - Street 1:37520 MULLIGAN DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-8081
Practice Address - Country:US
Practice Address - Phone:626-327-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily