Provider Demographics
NPI:1609448109
Name:CLERVEAU, CHARLENE (NP)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:CLERVEAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-3323
Mailing Address - Country:US
Mailing Address - Phone:978-437-7413
Mailing Address - Fax:
Practice Address - Street 1:19 TREMONT ST
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-3323
Practice Address - Country:US
Practice Address - Phone:978-437-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2322202163WP0200X
MA202325466363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WP0200XNursing Service ProvidersRegistered NursePediatrics