Provider Demographics
NPI:1659600781
Name:WINDSOR, CHARLENE POPE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:POPE
Last Name:WINDSOR
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 1:14574 COLORADO RD
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:MO
Mailing Address - Zip Code:65459-8262
Mailing Address - Country:US
Mailing Address - Phone:573-759-6815
Mailing Address - Fax:
Practice Address - Street 1:14574 COLORADO RD
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:MO
Practice Address - Zip Code:65459-8262
Practice Address - Country:US
Practice Address - Phone:573-759-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005040807163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2005040807OtherLICENSE