Provider Demographics
NPI:1558833319
Name:YATES, CHARLIE BOND (RN)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:BOND
Last Name:YATES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 GREEN HOLLOW RD SW
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-9706
Mailing Address - Country:US
Mailing Address - Phone:614-579-5544
Mailing Address - Fax:
Practice Address - Street 1:416 GREEN HOLLOW RD SW
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-9706
Practice Address - Country:US
Practice Address - Phone:614-579-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN243830163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse