Provider Demographics
NPI:1104229251
Name:NASH, CHARLES
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:NASH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 AMITY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-2117
Mailing Address - Country:US
Mailing Address - Phone:231-329-2421
Mailing Address - Fax:231-722-4771
Practice Address - Street 1:819 AMITY AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-2117
Practice Address - Country:US
Practice Address - Phone:231-329-2421
Practice Address - Fax:231-722-4771
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI610022171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator