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General NPI Number Information
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NPI Number | 1912341306
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Entity Type | Individual
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Provider Name | LORETTA B. CHARLES NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 87 PAINE MOUNTAIN DRIVE GREEN MOUNTAIN FAMILY PRACTICE
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City | NORTHFIELD
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State | VT
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Zip | 05663
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Country | US
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Telephone | 802-485-4161
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Fax | 802-485-4163
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Provider Business Mailing Address
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Address Line | PO BOX 547 ATT: CVMC FINANCE DEPT
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City | BARRE
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State | VT
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Zip | 05641-0547
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Country | US
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Telephone | 802-485-4161
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Fax | 802-485-4163
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 33 337930
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 101.00113985
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License Number State | VT
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