Provider Demographics
NPI:1700239290
Name:LOUIS-CHARLES, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:LOUIS-CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:DERODEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:857 PEPPERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1418
Mailing Address - Country:US
Mailing Address - Phone:516-385-4208
Mailing Address - Fax:
Practice Address - Street 1:857 PEPPERIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1418
Practice Address - Country:US
Practice Address - Phone:516-385-4208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY718763174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist