Provider Demographics
NPI:1699362442
Name:CASTON, CHARLENE SHAREY (RN)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:SHAREY
Last Name:CASTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2048
Mailing Address - Country:US
Mailing Address - Phone:856-449-3179
Mailing Address - Fax:
Practice Address - Street 1:806 WALNUT LN
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-2048
Practice Address - Country:US
Practice Address - Phone:856-449-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NPRN2600777900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1111111Medicaid