Provider Demographics
NPI:1639481740
Name:STIMSON, CHARISE (LPN)
Entity type:Individual
Prefix:MS
First Name:CHARISE
Middle Name:
Last Name:STIMSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08611-2332
Mailing Address - Country:US
Mailing Address - Phone:609-488-0568
Mailing Address - Fax:609-278-0458
Practice Address - Street 1:428 CENTRE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-2332
Practice Address - Country:US
Practice Address - Phone:609-488-0568
Practice Address - Fax:609-278-0458
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1521320800000X
CA4725745163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness