Provider Demographics
NPI:1982188561
Name:GAGE, CHARLOTTE ALYSHA RENE (RN)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ALYSHA RENE
Last Name:GAGE
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 1:3103 LONGHORN CIR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3277
Mailing Address - Country:US
Mailing Address - Phone:415-410-4625
Mailing Address - Fax:
Practice Address - Street 1:3103 LONGHORN CIR
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3277
Practice Address - Country:US
Practice Address - Phone:415-410-4625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA840046163W00000X
TX982545163WC1500X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty