Provider Demographics
NPI:1376968875
Name:PEEL, CHARLOTTE ELAINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ELAINE
Last Name:PEEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 W KEM RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2561
Mailing Address - Country:US
Mailing Address - Phone:765-662-7289
Mailing Address - Fax:765-662-4708
Practice Address - Street 1:1251 W KEM RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2561
Practice Address - Country:US
Practice Address - Phone:765-662-7289
Practice Address - Fax:765-662-4708
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily