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General NPI Number Information
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NPI Number | 1619750791
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Entity Type | Individual
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Provider Name | CHARISE J VIRGO LPN
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Gender | Female
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 22 ELM ST FL 1
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City | MORRISTOWN
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State | NJ
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Zip | 07960-8803
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Country | US
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Telephone | 973-267-5339
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Fax |
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Provider Business Mailing Address
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Address Line | 2097 MORRIS AVE APT 142
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City | UNION
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State | NJ
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Zip | 07083-6077
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Country | US
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Telephone | 908-623-9125
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 26NP06217400
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License Number State | NJ
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