Healthcare Provider Details

I. General information

NPI: 1225101561
Provider Name (Legal Business Name): CHARLOTTE'S FASHIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S TELSHOR BLVD
LAS CRUCES NM
88011-4898
US

IV. Provider business mailing address

1900 S TELSHOR BLVD
LAS CRUCES NM
88011-4898
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-3903
  • Fax: 575-522-3903
Mailing address:
  • Phone: 575-522-3903
  • Fax: 575-522-3903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHARLOTTE SUE DEERMAN
Title or Position: MEMBER/MANAGER
Credential: CMF
Phone: 575-522-3903