Provider Demographics
NPI:1265208243
Name:MARDNER, CHARNELE (QDDP)
Entity type:Individual
Prefix:
First Name:CHARNELE
Middle Name:
Last Name:MARDNER
Suffix:
Gender:F
Credentials:QDDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 RIVERSIDE PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-1094
Mailing Address - Country:US
Mailing Address - Phone:540-530-5545
Mailing Address - Fax:
Practice Address - Street 1:150 RIVERSIDE PKWY STE 115
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-1094
Practice Address - Country:US
Practice Address - Phone:540-530-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator