Provider Demographics
NPI:1669792016
Name:DAUGHERTY, CHARITA LEEANNE (STNA)
Entity type:Individual
Prefix:
First Name:CHARITA
Middle Name:LEEANNE
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 THORNWOOD DR
Mailing Address - Street 2:LOT 78
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-9500
Mailing Address - Country:US
Mailing Address - Phone:740-281-0028
Mailing Address - Fax:740-281-0028
Practice Address - Street 1:1100 THORNWOOD DR
Practice Address - Street 2:LOT 78
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-9500
Practice Address - Country:US
Practice Address - Phone:740-281-0028
Practice Address - Fax:740-281-0028
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374494460195376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide