Provider Demographics
NPI:1760857155
Name:HAFER, CHARITY CELESTE (RN)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:CELESTE
Last Name:HAFER
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 1:15119 W LILAC ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-3385
Mailing Address - Country:US
Mailing Address - Phone:614-226-8775
Mailing Address - Fax:
Practice Address - Street 1:4650 E COTTON CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-4800
Practice Address - Country:US
Practice Address - Phone:602-633-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ259936163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice