Provider Demographics
NPI:1366693640
Name:REID, CHARLENE MYERS (RN)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:MYERS
Last Name:REID
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 MIFFLIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2020
Mailing Address - Country:US
Mailing Address - Phone:215-463-5908
Mailing Address - Fax:
Practice Address - Street 1:1931 MIFFLIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2020
Practice Address - Country:US
Practice Address - Phone:215-463-5908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN523810L163W00000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice