Provider Demographics
NPI:1831927979
Name:CHARTERS, JACQUELYN
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:
Last Name:CHARTERS
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 1:5347 S PALATINO AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4461
Mailing Address - Country:US
Mailing Address - Phone:816-806-7151
Mailing Address - Fax:
Practice Address - Street 1:2015 S ORCHARD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-3639
Practice Address - Country:US
Practice Address - Phone:816-806-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging