Provider Demographics
NPI:1821683780
Name:HOLLERAN, CHARLOTTE MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:HOLLERAN
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 1:611 FELLSWAY W
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1849
Mailing Address - Country:US
Mailing Address - Phone:781-498-8221
Mailing Address - Fax:
Practice Address - Street 1:611 FELLSWAY W
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1849
Practice Address - Country:US
Practice Address - Phone:781-498-8221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN277786163WC0200X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine