Provider Demographics
NPI:1982633020
Name:ALTENBERGER, CHARLES A (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:A
Last Name:ALTENBERGER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:CHUCK
Other - Middle Name:A
Other - Last Name:ALTENBERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:10 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5214
Mailing Address - Country:US
Mailing Address - Phone:914-637-3510
Mailing Address - Fax:914-819-0061
Practice Address - Street 1:1321 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1665
Practice Address - Country:US
Practice Address - Phone:425-261-2000
Practice Address - Fax:425-261-4462
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006384367500000X
WARN00117378163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8881610Medicare PIN