Healthcare Provider Details

I. General information

NPI: 1558440461
Provider Name (Legal Business Name): CHARMANE HENRY-DAIGLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11705 S ALAMEDA ST DMH
LYNWOOD CA
90262-4023
US

IV. Provider business mailing address

11705 S ALAMEDA ST DMH
LYNWOOD CA
90262-4023
US

V. Phone/Fax

Practice location:
  • Phone: 323-568-4678
  • Fax:
Mailing address:
  • Phone: 323-568-4678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number525605
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number525605
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number525605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: