Provider Demographics
NPI:1295457083
Name:ESPADA, CHARLENE (RN)
Entity type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:ESPADA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8346 118TH ST APT 3I
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2318
Mailing Address - Country:US
Mailing Address - Phone:347-837-1713
Mailing Address - Fax:
Practice Address - Street 1:8346 118TH ST APT 3I
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2318
Practice Address - Country:US
Practice Address - Phone:347-837-1713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY784086163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse