Provider Demographics
NPI:1245961150
Name:LANDIS, CHARLI ANN (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:CHARLI
Middle Name:ANN
Last Name:LANDIS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58134 COUNTY ROAD 9
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:OH
Mailing Address - Zip Code:43845-9717
Mailing Address - Country:US
Mailing Address - Phone:740-294-0596
Mailing Address - Fax:
Practice Address - Street 1:58134 COUNTY ROAD 9
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:OH
Practice Address - Zip Code:43845-9717
Practice Address - Country:US
Practice Address - Phone:740-294-0596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily