Provider Demographics
NPI:1760920516
Name:CHARLIE, ELEANOR
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:CHARLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101KUURARALRIA STREET
Mailing Address - Street 2:
Mailing Address - City:NIGHTMUTE
Mailing Address - State:AK
Mailing Address - Zip Code:99690
Mailing Address - Country:US
Mailing Address - Phone:907-647-6312
Mailing Address - Fax:907-647-5872
Practice Address - Street 1:101 KUURARALRIA STREET
Practice Address - Street 2:
Practice Address - City:NIGHTMUTE
Practice Address - State:AK
Practice Address - Zip Code:99690
Practice Address - Country:US
Practice Address - Phone:907-647-6312
Practice Address - Fax:907-647-5872
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker