Provider Demographics
NPI:1154975209
Name:WHITE, CHARNELENE BARBARA
Entity type:Individual
Prefix:
First Name:CHARNELENE
Middle Name:BARBARA
Last Name:WHITE
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 1:108 OLDE TOWNE AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2099
Mailing Address - Country:US
Mailing Address - Phone:240-418-8230
Mailing Address - Fax:
Practice Address - Street 1:3261 THEODORE R HAGANS DR NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-4317
Practice Address - Country:US
Practice Address - Phone:417-948-8315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide