Provider Demographics
NPI:1588481154
Name:PIAD, CHARLENE ROSE BARRERA (BSN, RN)
Entity type:Individual
Prefix:
First Name:CHARLENE ROSE
Middle Name:BARRERA
Last Name:PIAD
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:CHARLENE ROSE
Other - Middle Name:TAVARRO
Other - Last Name:BARRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:2242 SCOTT SATHER DR
Mailing Address - Street 2:
Mailing Address - City:JBSA LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236-1058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1940 CARSWELL AVE BLDG 7002
Practice Address - Street 2:
Practice Address - City:JBSA LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236-5514
Practice Address - Country:US
Practice Address - Phone:210-292-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069803163W00000X
OH478911163W00000X
AK120579163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse