Provider Demographics
NPI:1013292671
Name:CHARBONNIER, ELAINE ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:ANN
Last Name:CHARBONNIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:ANN
Other - Last Name:COKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1153 CENTRE ST
Mailing Address - Street 2:FAULKNER HOSPITAL , DEPT OF PREADMISSION TESTING
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3446
Mailing Address - Country:US
Mailing Address - Phone:617-933-4600
Mailing Address - Fax:617-983-7723
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:FAULKNER HOSPITAL , DEPT OF PREADMISSION TESTING
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-933-4600
Practice Address - Fax:617-983-7723
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN157542363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS38613Medicare UPIN