Provider Demographics
NPI:1841490554
Name:FERRELL, CHARLOTTE (FPMHNP)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:
Last Name:FERRELL
Suffix:
Gender:F
Credentials:FPMHNP
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:
Other - Last Name:FERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NS
Mailing Address - Street 1:316 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5218
Mailing Address - Country:US
Mailing Address - Phone:701-774-4600
Mailing Address - Fax:701-774-4620
Practice Address - Street 1:316 2ND AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5218
Practice Address - Country:US
Practice Address - Phone:701-774-4600
Practice Address - Fax:701-774-4620
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR29630363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health