Provider Demographics
NPI:1689085987
Name:DUCHARME, CAREN (LAC)
Entity Type:Individual
Prefix:
First Name:CAREN
Middle Name:
Last Name:DUCHARME
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 W FERRUCCIO PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3218
Mailing Address - Country:US
Mailing Address - Phone:623-521-2608
Mailing Address - Fax:
Practice Address - Street 1:20325 N 51ST AVE STE 112
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5665
Practice Address - Country:US
Practice Address - Phone:623-521-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0927171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist