Healthcare Provider Details

I. General information

NPI: 1780197194
Provider Name (Legal Business Name): JUNNIE ANGELINA CHARLES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 FULTON ST
BOSTON MA
02109-1402
US

IV. Provider business mailing address

70 FULTON ST
BOSTON MA
02109-1402
US

V. Phone/Fax

Practice location:
  • Phone: 781-404-7045
  • Fax:
Mailing address:
  • Phone: 781-404-7045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2321259
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: