Provider Demographics
NPI:1699001792
Name:BRONSON, CHARITIE ANNE (BS)
Entity Type:Individual
Prefix:MRS
First Name:CHARITIE
Middle Name:ANNE
Last Name:BRONSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5916 BIG HORN VIEW ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-6806
Mailing Address - Country:US
Mailing Address - Phone:702-612-3716
Mailing Address - Fax:702-834-3544
Practice Address - Street 1:5916 BIG HORN VIEW ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-6806
Practice Address - Country:US
Practice Address - Phone:702-612-3716
Practice Address - Fax:702-834-3544
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner