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General NPI Number Information
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NPI Number | 1659961167
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Entity Type | Individual
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Provider Name | CHARLOTTE RENA LASTER CPT, X-RAY TECH, CMA
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Gender | Female
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 231 S VALLEY ST
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City | CARTHAGE
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State | MS
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Zip | 39051-4047
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Country | US
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Telephone | 601-654-2087
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Fax |
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Provider Business Mailing Address
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Address Line | 231 S VALLEY ST
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City | CARTHAGE
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State | MS
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Zip | 39051-4047
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Country | US
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Telephone | 601-654-2087
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1049271
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License Number State | MS
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