Provider Demographics
NPI:1467890327
Name:SINGH, CHARLEEN (FNP)
Entity Type:Individual
Prefix:
First Name:CHARLEEN
Middle Name:
Last Name:SINGH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHARLEEN
Other - Middle Name:
Other - Last Name:DEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3001 DOUGLAS BLVD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3851
Mailing Address - Country:US
Mailing Address - Phone:916-241-9844
Mailing Address - Fax:
Practice Address - Street 1:3001 DOUGLAS BLVD
Practice Address - Street 2:SUITE 325
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3851
Practice Address - Country:US
Practice Address - Phone:916-241-9844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22601363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA128089OtherMEDICARE