Provider Demographics
NPI:1891951695
Name:CHARLES, LOURDESSE (LPN)
Entity type:Individual
Prefix:
First Name:LOURDESSE
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 FERNWOOD TER
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-5211
Mailing Address - Country:US
Mailing Address - Phone:908-906-0395
Mailing Address - Fax:
Practice Address - Street 1:620 E 13TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-1553
Practice Address - Country:US
Practice Address - Phone:908-906-0395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY790259-01163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health