Provider Demographics
NPI:1487185682
Name:LEARY, CHARLOTTE-ANNE (RN)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE-ANNE
Middle Name:
Last Name:LEARY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 WILSON RD
Mailing Address - Street 2:UNIT 12
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-4600
Mailing Address - Country:US
Mailing Address - Phone:508-642-9141
Mailing Address - Fax:508-679-3325
Practice Address - Street 1:1170 WILSON RD
Practice Address - Street 2:UNIT 12
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-4600
Practice Address - Country:US
Practice Address - Phone:508-642-9141
Practice Address - Fax:508-679-3325
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2310968163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse