Healthcare Provider Details

I. General information

NPI: 1730684887
Provider Name (Legal Business Name): SANDRA JOANA LOUIS-CHARLES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA JOANA COULANGES RN

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAIN ST STE 222
CHARLESTOWN MA
02129-1101
US

IV. Provider business mailing address

529 MAIN ST STE 222
CHARLESTOWN MA
02129-1101
US

V. Phone/Fax

Practice location:
  • Phone: 617-426-0600
  • Fax:
Mailing address:
  • Phone: 617-426-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN2275955
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: