Provider Demographics
NPI:1194469791
Name:BROSIUS, CHARLENE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:
Last Name:BROSIUS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7183 SCHULTZ RD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-9646
Mailing Address - Country:US
Mailing Address - Phone:716-512-8474
Mailing Address - Fax:
Practice Address - Street 1:7183 SCHULTZ RD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-9646
Practice Address - Country:US
Practice Address - Phone:716-512-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297962-01163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health