Provider Demographics
NPI:1598370942
Name:FATIREGUN, CHARLOTTE LAWRENTA (FNP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:LAWRENTA
Last Name:FATIREGUN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 HIDDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8705
Mailing Address - Country:US
Mailing Address - Phone:646-261-6656
Mailing Address - Fax:
Practice Address - Street 1:221 HIDDEN LAKE DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8705
Practice Address - Country:US
Practice Address - Phone:646-261-6656
Practice Address - Fax:866-640-1580
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1012433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily