Provider Demographics
NPI:1821242884
Name:BOOSE, CHARMAINE SHERESE
Entity Type:Individual
Prefix:MS
First Name:CHARMAINE
Middle Name:SHERESE
Last Name:BOOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHARMAINE
Other - Middle Name:SHERESE
Other - Last Name:BOOSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:10437 W JONEN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-5126
Mailing Address - Country:US
Mailing Address - Phone:414-461-5387
Mailing Address - Fax:
Practice Address - Street 1:10437 W JONEN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-5126
Practice Address - Country:US
Practice Address - Phone:414-461-5387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI306046-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse