Provider Demographics
NPI:1801328679
Name:SOMARU, CHARLENE MICALE (CRNP-FAMILY)
Entity type:Individual
Prefix:MISS
First Name:CHARLENE
Middle Name:MICALE
Last Name:SOMARU
Suffix:
Gender:F
Credentials:CRNP-FAMILY
Other - Prefix:MRS
Other - First Name:CHARLENE
Other - Middle Name:FAYETTE
Other - Last Name:FILS-AIME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3350 CRAIN HWY
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4850
Mailing Address - Country:US
Mailing Address - Phone:188-808-6483
Mailing Address - Fax:
Practice Address - Street 1:7503 SURRATTS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3358
Practice Address - Country:US
Practice Address - Phone:864-275-7917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL11008875363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program