Provider Demographics
NPI:1932374907
Name:EGGEMAN, CHARLENE VIVEIROS (RN CDOE)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:VIVEIROS
Last Name:EGGEMAN
Suffix:
Gender:F
Credentials:RN CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MALEE TERRACE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871
Mailing Address - Country:US
Mailing Address - Phone:401-849-5438
Mailing Address - Fax:
Practice Address - Street 1:50 MEMORIAL BLVD
Practice Address - Street 2:AQUIDNECK MEDICAL ASSOCIATES INC
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840
Practice Address - Country:US
Practice Address - Phone:401-847-2290
Practice Address - Fax:401-849-8446
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN27917163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse