Provider Demographics
NPI:1689436313
Name:CHARLES, REMENDA M
Entity Type:Individual
Prefix:
First Name:REMENDA
Middle Name:M
Last Name:CHARLES
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 1:725 BILLINGS AVE
Mailing Address - Street 2:
Mailing Address - City:PAULSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08066-1216
Mailing Address - Country:US
Mailing Address - Phone:856-599-1595
Mailing Address - Fax:
Practice Address - Street 1:1655 SWEDESBORO AVE
Practice Address - Street 2:
Practice Address - City:PAULSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08066-1533
Practice Address - Country:US
Practice Address - Phone:856-599-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty