Provider Demographics
NPI:1437629425
Name:SIROIN, CHARLENE JOHANNAH
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:JOHANNAH
Last Name:SIROIN
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 1:19465 EVENING STAR WAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-7102
Mailing Address - Country:US
Mailing Address - Phone:651-895-2718
Mailing Address - Fax:
Practice Address - Street 1:19465 EVENING STAR WAY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-7102
Practice Address - Country:US
Practice Address - Phone:651-895-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician