Provider Demographics
NPI:1427575398
Name:FINCHUM, CHARLOTTE
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:FINCHUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:VA
Mailing Address - Zip Code:23942-0162
Mailing Address - Country:US
Mailing Address - Phone:434-414-4955
Mailing Address - Fax:
Practice Address - Street 1:593 KEELING DR
Practice Address - Street 2:SITE 12 B SECTION
Practice Address - City:KEELING
Practice Address - State:VA
Practice Address - Zip Code:24566
Practice Address - Country:US
Practice Address - Phone:434-414-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver