Provider Demographics
NPI:1932863784
Name:CHARLES, PIERRE D (MSN, RN, CCM)
Entity Type:Individual
Prefix:MR
First Name:PIERRE
Middle Name:D
Last Name:CHARLES
Suffix:
Gender:M
Credentials:MSN, RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-5206
Mailing Address - Country:US
Mailing Address - Phone:781-539-9767
Mailing Address - Fax:
Practice Address - Street 1:25 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-5206
Practice Address - Country:US
Practice Address - Phone:781-539-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2281239163WA2000X, 163WC1600X, 163WH0200X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WH0200XNursing Service ProvidersRegistered NurseHome Health