MEDICARE: MS. MICHAELLE JEAN-CHARLES LPN

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	164W00000X	Licensed Practical Nurse	PN 5202212	FL

General Provider Information

NPI Number	:	1457600710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHAELLE JEAN-CHARLES LPN

Provider Business Mailing Address
First Line	:	1180 NE 137TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-3822
Country	:	US
Telephone Number	:	786-370-9672
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 NE 137TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-3822
Country	:	US
Telephone Number	:	786-370-9672
Fax Number	:

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

Provider Enumeration Date	:	09/02/2012
Last Update Date	:	09/02/2012

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