Provider Demographics
NPI:1457600710
Name:JEAN-CHARLES, MICHAELLE (LPN)
Entity Type:Individual
Prefix:MS
First Name:MICHAELLE
Middle Name:
Last Name:JEAN-CHARLES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:MICHAELLE
Other - Middle Name:
Other - Last Name:JEAN-CHARLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:1180 NE 137TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-3822
Mailing Address - Country:US
Mailing Address - Phone:786-370-9672
Mailing Address - Fax:
Practice Address - Street 1:1180 NE 137TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-3822
Practice Address - Country:US
Practice Address - Phone:786-370-9672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN 5202212164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse