Provider Demographics
NPI:1598913055
Name:RICHIE, CHARLES HEWITT (RN)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:HEWITT
Last Name:RICHIE
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 1:330 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4375
Mailing Address - Country:US
Mailing Address - Phone:559-832-3211
Mailing Address - Fax:559-589-0482
Practice Address - Street 1:330 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4375
Practice Address - Country:US
Practice Address - Phone:559-582-3211
Practice Address - Fax:559-589-0482
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN676536163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA261QP0905XMedicaid