Provider Demographics
NPI:1700202884
Name:OGONOWSKI, CHARLENE (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:OGONOWSKI
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 E BROOMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-5429
Mailing Address - Country:US
Mailing Address - Phone:989-772-2541
Mailing Address - Fax:
Practice Address - Street 1:1625 E BROOMFIELD ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-5429
Practice Address - Country:US
Practice Address - Phone:989-772-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704210575363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care