Provider Demographics
NPI:1770290744
Name:SCHWAN, CHARLENE A
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:A
Last Name:SCHWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:A
Other - Last Name:JAEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1438 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3010
Mailing Address - Country:US
Mailing Address - Phone:701-866-7680
Mailing Address - Fax:
Practice Address - Street 1:1438 10TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3010
Practice Address - Country:US
Practice Address - Phone:701-866-7680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No177F00000XOther Service ProvidersLodging
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals