Healthcare Provider Details

I. General information

NPI: 1962800144
Provider Name (Legal Business Name): CHARM CITY HOUSE CALLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 ABELL AVE
BALTIMORE MD
21218-3411
US

IV. Provider business mailing address

3118 ABELL AVE
BALTIMORE MD
21218-3411
US

V. Phone/Fax

Practice location:
  • Phone: 443-226-5597
  • Fax:
Mailing address:
  • Phone: 443-226-5597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DORIAN FRACKELTON
Title or Position: OWNER/NURSE PRACTITIONER
Credential: FNP
Phone: 443-226-5597