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General NPI Number Information
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NPI Number | 1891951695
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Entity Type | Individual
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Provider Name | LOURDESSE CHARLES LPN
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Gender | Female
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 620 E 13TH ST
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City | NEW YORK
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State | NY
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Zip | 10009-1553
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Country | US
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Telephone | 908-906-0395
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Fax |
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Provider Business Mailing Address
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Address Line | 325 FERNWOOD TER
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City | LINDEN
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State | NJ
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Zip | 07036-5211
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Country | US
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Telephone | 908-906-0395
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 790259-01
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License Number State | NY
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