Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | F302984 | NY |
N | 363L00000X | Nurse Practitioner | F333843 | NY |
NPI | 1013034651 |
---|---|
Provider Name | Ms. Camelle Charles |
First Address | New Hyde Park, NY 11040-1433 |
Second Address | New Hyde Park, NY 11040-1433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 08/07/2007 |