Provider Demographics
NPI:1417929654
Name:CHARLES, MAUREEN ANN (NP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANN
Last Name:CHARLES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:ANN
Other - Last Name:KUSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNIT 3050 BOX 130
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09021-3050
Mailing Address - Country:US
Mailing Address - Phone:314-480-4687
Mailing Address - Fax:
Practice Address - Street 1:86 MDG
Practice Address - Street 2:
Practice Address - City:RAMSTEIN AB APO AE
Practice Address - State:NY
Practice Address - Zip Code:09012
Practice Address - Country:US
Practice Address - Phone:314-479-2612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX659573363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
104288777OtherNATIONAL CERTIFICATION CORPORATION