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General NPI Number Information
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NPI Number | 1952792236
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Entity Type | Individual
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Provider Name | CHARLOTTE R RADIC CNM, APRN
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Gender | Female
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 800 ROSE ST
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City | LEXINGTON
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State | KY
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Zip | 40536-2619
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Country | US
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Telephone | 859-323-5931
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Fax | 859-257-7520
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Provider Business Mailing Address
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Address Line | PO BOX 1430
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City | PORTAGE
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State | IN
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Zip | 46368-9230
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Country | US
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Telephone | 219-763-8112
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Fax | 219-764-3251
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 09000259A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 29843
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 3018119
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License Number State | KY
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