Provider Demographics
NPI:1770860975
Name:BEGNAUD, CHARLIE J II (CRNA)
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:J
Last Name:BEGNAUD
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-5431
Mailing Address - Country:US
Mailing Address - Phone:603-882-1501
Mailing Address - Fax:603-882-9747
Practice Address - Street 1:168 KINSLEY ST
Practice Address - Street 2:SUITE 4
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3634
Practice Address - Country:US
Practice Address - Phone:603-882-1501
Practice Address - Fax:603-882-9747
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH06528323367500000X
IN28224409A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201304560Medicaid
IN000000952986OtherANTHEM PROVIDER NUMBER
IN201304560Medicaid
IN815500103Medicare PIN