Provider Demographics
NPI:1568656700
Name:VANCHURA CANDELARIA, CHARLOTTE A (RN)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:A
Last Name:VANCHURA CANDELARIA
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 1:106 SHULER DR
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-9516
Mailing Address - Country:US
Mailing Address - Phone:907-747-5488
Mailing Address - Fax:
Practice Address - Street 1:106 SHULER DR
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9516
Practice Address - Country:US
Practice Address - Phone:907-747-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK25209163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse