Healthcare Provider Details

I. General information

NPI: 1932863784
Provider Name (Legal Business Name): PIERRE D CHARLES MSN, RN, CCM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ADAMS AVE
EVERETT MA
02149-5206
US

IV. Provider business mailing address

25 ADAMS AVE
EVERETT MA
02149-5206
US

V. Phone/Fax

Practice location:
  • Phone: 781-539-9767
  • Fax:
Mailing address:
  • Phone: 781-539-9767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN2281239
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN2281239
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2281239
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN2281239
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: