Provider Demographics
NPI:1962884056
Name:CHARLES, BRIANNA CHRYSTINE
Entity type:Individual
Prefix:MISS
First Name:BRIANNA
Middle Name:CHRYSTINE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 AGATE MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-1463
Mailing Address - Country:US
Mailing Address - Phone:541-879-1697
Mailing Address - Fax:
Practice Address - Street 1:2515 AGATE MEADOWS CT
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-1463
Practice Address - Country:US
Practice Address - Phone:541-879-1697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker