Healthcare Provider Details

I. General information

NPI: 1891951695
Provider Name (Legal Business Name): LOURDESSE CHARLES LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E 13TH ST
NEW YORK NY
10009-1553
US

IV. Provider business mailing address

325 FERNWOOD TER
LINDEN NJ
07036-5211
US

V. Phone/Fax

Practice location:
  • Phone: 908-906-0395
  • Fax:
Mailing address:
  • Phone: 908-906-0395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number790259-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: