Provider Demographics
NPI:1245270206
Name:CHARLES, CARISE ELIZABETH (NP)
Entity type:Individual
Prefix:MRS
First Name:CARISE
Middle Name:ELIZABETH
Last Name:CHARLES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6841 GALA ST
Mailing Address - Street 2:HIGHLAND
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-2766
Mailing Address - Country:US
Mailing Address - Phone:916-654-2431
Mailing Address - Fax:916-654-3186
Practice Address - Street 1:3102 EAST HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PATTON
Practice Address - State:CA
Practice Address - Zip Code:92369
Practice Address - Country:US
Practice Address - Phone:909-425-7844
Practice Address - Fax:909-862-0718
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN334333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S66781Medicare UPIN
ZZZ15490ZMedicare ID - Type Unspecified