Provider Demographics
NPI:1790228740
Name:CHARLTON, BRIANNA
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:CHARLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 WINDOM RD
Mailing Address - Street 2:APT 4
Mailing Address - City:BRENTWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20722-1046
Mailing Address - Country:US
Mailing Address - Phone:202-390-0827
Mailing Address - Fax:
Practice Address - Street 1:3511 WINDOM RD
Practice Address - Street 2:APT 4
Practice Address - City:BRENTWOOD
Practice Address - State:MD
Practice Address - Zip Code:20722-1046
Practice Address - Country:US
Practice Address - Phone:202-390-0827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide