Provider Demographics
NPI:1225101561
Name:CHARLOTTE'S FASHIONS, LLC
Entity Type:Organization
Organization Name:CHARLOTTE'S FASHIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:DEERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:575-522-3903
Mailing Address - Street 1:1900 S TELSHOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4898
Mailing Address - Country:US
Mailing Address - Phone:575-522-3903
Mailing Address - Fax:575-522-3903
Practice Address - Street 1:1900 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4898
Practice Address - Country:US
Practice Address - Phone:575-522-3903
Practice Address - Fax:575-522-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00TB34OtherBLUE CROSS BLUE SHIELD
NM6310350001Medicare NSC