Healthcare Provider Details

I. General information

NPI: 1760857155
Provider Name (Legal Business Name): CHARITY CELESTE HAFER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 E COTTON CENTER BLVD
PHOENIX AZ
85040-4800
US

IV. Provider business mailing address

15119 W LILAC ST
GOODYEAR AZ
85338-3385
US

V. Phone/Fax

Practice location:
  • Phone: 602-633-1828
  • Fax:
Mailing address:
  • Phone: 614-226-8775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number259936
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: