Provider Demographics
NPI:1629171293
Name:MISORI, CHARLES ITOE (CRNP)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ITOE
Last Name:MISORI
Suffix:
Gender:M
Credentials:CRNP
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Mailing Address - Street 1:14500 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8360
Mailing Address - Country:US
Mailing Address - Phone:256-694-1277
Mailing Address - Fax:
Practice Address - Street 1:2223 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-8646
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:786-558-0242
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1094507363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily