Healthcare Provider Details

I. General information

NPI: 1639076276
Provider Name (Legal Business Name): JULIEN CHARLES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2026
Last Update Date: 10/26/2026
Certification Date: 10/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4764 47TH AVE S
FARGO ND
58104-6036
US

IV. Provider business mailing address

4764 47TH AVE S
FARGO ND
58104-6036
US

V. Phone/Fax

Practice location:
  • Phone: 701-936-1417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: