Provider Demographics
NPI:1255309118
Name:RYDBERG, CHARLOTTE L (PNP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:L
Last Name:RYDBERG
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:L
Other - Last Name:LANDHOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ONE PEARL STREET
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2865
Mailing Address - Country:US
Mailing Address - Phone:508-894-8577
Mailing Address - Fax:508-894-8578
Practice Address - Street 1:ONE PEARL STREET
Practice Address - Street 2:SUITE 2000
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2865
Practice Address - Country:US
Practice Address - Phone:508-894-8577
Practice Address - Fax:508-894-8578
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA117777164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse