Provider Demographics
NPI:1770670721
Name:CLINE, CHARLOTTE MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:CLINE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 JASON LN
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-8633
Mailing Address - Country:US
Mailing Address - Phone:504-392-3532
Mailing Address - Fax:
Practice Address - Street 1:3501 SEVERN AVE STE 8
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3456
Practice Address - Country:US
Practice Address - Phone:985-479-8000
Practice Address - Fax:504-835-0565
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARNO64244APO3780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1108090Medicaid
LAP36646Medicare UPIN