Provider Demographics
NPI:1467784512
Name:REID, CHARLENE C (LPN)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:C
Last Name:REID
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7538 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-3507
Mailing Address - Country:US
Mailing Address - Phone:570-994-4236
Mailing Address - Fax:
Practice Address - Street 1:7538 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-3507
Practice Address - Country:US
Practice Address - Phone:570-994-4236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-31
Last Update Date:2010-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN283133164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse