MEDICARE: CHARNELE MATHIES NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN626706	PA
2	363LF0000X	Family Nurse Practitioner	SP022846	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VADOO	OTHER		UPIN

General Provider Information

NPI Number	:	1073983771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARNELE MATHIES NP-C

Provider Business Mailing Address
First Line	:	817 JEFFERSON AVE
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-3822
Country	:	US
Telephone Number	:	724-249-2517
Fax Number	:

Provider Business Practice Location Address
First Line	:	817 JEFFERSON AVE
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-3822
Country	:	US
Telephone Number	:	724-249-2517
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	02/14/2023

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Directions to “ CHARNELE MATHIES NP-C” Practice Location

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