Provider Demographics
NPI:1558863290
Name:CHARLES, MARIE ATAMENE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ATAMENE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ATAMENE
Other - Last Name:PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4485 ISLAND REEF DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8392
Mailing Address - Country:US
Mailing Address - Phone:561-537-3868
Mailing Address - Fax:561-537-3868
Practice Address - Street 1:4485 ISLAND REEF DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8392
Practice Address - Country:US
Practice Address - Phone:561-537-3868
Practice Address - Fax:561-537-3868
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9195177163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty