Provider Demographics
NPI:1689101412
Name:SHEELER, CHARISE (LPN)
Entity Type:Individual
Prefix:
First Name:CHARISE
Middle Name:
Last Name:SHEELER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 ROSLYN AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-2025
Mailing Address - Country:US
Mailing Address - Phone:234-804-7257
Mailing Address - Fax:
Practice Address - Street 1:1115 ROSLYN AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-2025
Practice Address - Country:US
Practice Address - Phone:234-804-7257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH124-689MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse