Provider Demographics
NPI:1396289492
Name:CAVERLY, CHARITY (FNP-BC)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:CAVERLY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-670-1498
Mailing Address - Fax:
Practice Address - Street 1:8767 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48609-4823
Practice Address - Country:US
Practice Address - Phone:989-781-1124
Practice Address - Fax:989-781-0950
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704158622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily