Provider Demographics
NPI:1962623975
Name:POUNCIL, CHARLETTE MARIE (LVN)
Entity type:Individual
Prefix:MRS
First Name:CHARLETTE
Middle Name:MARIE
Last Name:POUNCIL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2071 GORDON VERNER CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-6116
Mailing Address - Country:US
Mailing Address - Phone:510-253-3791
Mailing Address - Fax:
Practice Address - Street 1:1628 BROADWAY ST STE B
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-2405
Practice Address - Country:US
Practice Address - Phone:707-649-8300
Practice Address - Fax:707-649-8200
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN189583164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse