MEDICARE: STEPHANIE CHARLES LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1073378931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE CHARLES LPN

Provider Business Mailing Address
First Line	:	9713 BEREA ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1723
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 W SOMERVILLE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-2904
Country	:	US
Telephone Number	:	267-304-6775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2024
Last Update Date	:	02/19/2024

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Directions to “ STEPHANIE CHARLES LPN” Practice Location

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