Healthcare Provider Details

I. General information

NPI: 1487462248
Provider Name (Legal Business Name): CHARLEE RENE VINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 SHERIFF RD NE
WASHINGTON DC
20019-3739
US

IV. Provider business mailing address

1113 21ST ST NE APT 102
WASHINGTON DC
20002-3184
US

V. Phone/Fax

Practice location:
  • Phone: 202-248-3434
  • Fax:
Mailing address:
  • Phone: 202-361-9930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: