Provider Demographics
NPI:1215783774
Name:CHARLIE, TRISHA DARLENE (NACNC61445166)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:DARLENE
Last Name:CHARLIE
Suffix:
Gender:F
Credentials:NACNC61445166
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-3927
Mailing Address - Country:US
Mailing Address - Phone:360-589-7279
Mailing Address - Fax:
Practice Address - Street 1:2324 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-3927
Practice Address - Country:US
Practice Address - Phone:360-589-7279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANAC.NC.61445166374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide