Provider Demographics
NPI:1376118240
Name:CHARLES, KATRINA (STNA)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 GUNSTON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-6272
Mailing Address - Country:US
Mailing Address - Phone:614-424-2780
Mailing Address - Fax:
Practice Address - Street 1:5041 GUNSTON DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-6272
Practice Address - Country:US
Practice Address - Phone:614-424-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400844591208251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health