Provider Demographics
NPI:1619212701
Name:FIELDS, CHARLENE G (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:G
Last Name:FIELDS
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 1:230 N KENWOOD ST
Mailing Address - Street 2:APT. 308
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3974
Mailing Address - Country:US
Mailing Address - Phone:719-238-9453
Mailing Address - Fax:
Practice Address - Street 1:6303 OWENSMOUTH AVE
Practice Address - Street 2:FL. 10
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2264
Practice Address - Country:US
Practice Address - Phone:323-391-1622
Practice Address - Fax:323-391-1622
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA812023163W00000X
CO161553163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse