Provider Demographics
NPI:1891572988
Name:LASURE, CHARITY GAIL
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:GAIL
Last Name:LASURE
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 1:608 BELLVIEW BLVD APT 26
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1802
Mailing Address - Country:US
Mailing Address - Phone:417-718-6048
Mailing Address - Fax:
Practice Address - Street 1:608 BELLVIEW BLVD APT 26
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1802
Practice Address - Country:US
Practice Address - Phone:417-718-6048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant