Provider Demographics
NPI:1467764688
Name:ANGELINI, CHARLOTTE (MSOM, LAC)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:
Last Name:ANGELINI
Suffix:
Gender:F
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 MCHENRY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1825
Mailing Address - Country:US
Mailing Address - Phone:262-763-9355
Mailing Address - Fax:262-342-5151
Practice Address - Street 1:149 MCHENRY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1825
Practice Address - Country:US
Practice Address - Phone:262-763-9355
Practice Address - Fax:262-342-5151
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI619-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist