Provider Demographics
NPI:1700456167
Name:GLOVER, CHARLOTTE BOSEMAN (LPN)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:BOSEMAN
Last Name:GLOVER
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 1:341 W BELTLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-1505
Mailing Address - Country:US
Mailing Address - Phone:864-222-9798
Mailing Address - Fax:
Practice Address - Street 1:341 W BELTLINE BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-1505
Practice Address - Country:US
Practice Address - Phone:864-222-9798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40394164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse