Provider Demographics
NPI:1457923013
Name:DUPREE-HENEGAN, CHARISSE (REGISTER NURSE)
Entity Type:Individual
Prefix:MRS
First Name:CHARISSE
Middle Name:
Last Name:DUPREE-HENEGAN
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PEGONIA LN
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-7234
Mailing Address - Country:US
Mailing Address - Phone:803-605-4161
Mailing Address - Fax:
Practice Address - Street 1:210 PEGONIA LN
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-7234
Practice Address - Country:US
Practice Address - Phone:803-605-4161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC203456163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice