Provider Demographics
NPI:1639996499
Name:SEGRAVES, CHARLOTTE E
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:E
Last Name:SEGRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 MOCCASIN CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-3414
Mailing Address - Country:US
Mailing Address - Phone:317-726-6038
Mailing Address - Fax:
Practice Address - Street 1:3302 MOCCASIN CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-3414
Practice Address - Country:US
Practice Address - Phone:317-726-6038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN240017511251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health