Provider Demographics
NPI:1629370218
Name:FRIEDLANDER, CHARLENE A (RN)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:A
Last Name:FRIEDLANDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:A
Other - Last Name:LUDWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:P.O. BOX 880
Mailing Address - Street 2:
Mailing Address - City:ST. IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865
Mailing Address - Country:US
Mailing Address - Phone:406-745-3525
Mailing Address - Fax:406-745-4235
Practice Address - Street 1:5 4TH AVE EAST
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860
Practice Address - Country:US
Practice Address - Phone:406-883-5541
Practice Address - Fax:406-883-3193
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22129163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse