Provider Demographics
NPI:1699202119
Name:ECHEVERRIA, CHARLIE ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:ANNE
Last Name:ECHEVERRIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1565
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-1565
Mailing Address - Country:US
Mailing Address - Phone:307-365-6825
Mailing Address - Fax:307-459-0069
Practice Address - Street 1:3510 N LAKE CREEK DR
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-9695
Practice Address - Country:US
Practice Address - Phone:307-365-6825
Practice Address - Fax:307-459-0069
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60975308207Q00000X
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program