Provider Demographics
NPI:1962643734
Name:CHARLES, CHRISTINA ALICE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:ALICE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1010 HAZEN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1399
Mailing Address - Country:US
Mailing Address - Phone:718-546-6257
Mailing Address - Fax:718-546-6256
Practice Address - Street 1:1010 HAZEN ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1399
Practice Address - Country:US
Practice Address - Phone:718-546-6257
Practice Address - Fax:718-546-6256
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400690-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health