Provider Demographics
NPI:1831177781
Name:COVILL, CHARLTON RICHARD (RN - CRNFA)
Entity type:Individual
Prefix:MR
First Name:CHARLTON
Middle Name:RICHARD
Last Name:COVILL
Suffix:
Gender:M
Credentials:RN - CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15629 E SANOQUE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-9421
Mailing Address - Country:US
Mailing Address - Phone:480-814-7132
Mailing Address - Fax:
Practice Address - Street 1:15629 E SANOQUE BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-9421
Practice Address - Country:US
Practice Address - Phone:480-814-7132
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN063578364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative