Provider Demographics
NPI:1609974369
Name:CHARLES, CAROL LINDA
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LINDA
Last Name:CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LINDA
Other - Last Name:LENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:715 W 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1913
Mailing Address - Country:US
Mailing Address - Phone:509-838-2235
Mailing Address - Fax:
Practice Address - Street 1:2903 E 25TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4992
Practice Address - Country:US
Practice Address - Phone:509-536-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007477363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner