Provider Demographics
NPI:1639588064
Name:KIRTON, CHARLOTTE
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:
Last Name:KIRTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5351 LAKESPRING DR
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3142
Mailing Address - Country:US
Mailing Address - Phone:510-860-0512
Mailing Address - Fax:
Practice Address - Street 1:5351 LAKESPRING DR
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-3142
Practice Address - Country:US
Practice Address - Phone:510-943-2948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19351363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner