Provider Demographics
NPI:1558440461
Name:HENRY-DAIGLE, CHARMANE (RN)
Entity Type:Individual
Prefix:
First Name:CHARMANE
Middle Name:
Last Name:HENRY-DAIGLE
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 1:11705 S ALAMEDA ST
Mailing Address - Street 2:DMH
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-4023
Mailing Address - Country:US
Mailing Address - Phone:323-568-4678
Mailing Address - Fax:
Practice Address - Street 1:11705 S ALAMEDA ST
Practice Address - Street 2:DMH
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4023
Practice Address - Country:US
Practice Address - Phone:323-568-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA525605163WP0808X, 390200000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)