MEDICARE: ANGELA KATRI CHARLESTON

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	125689	OH

General Provider Information

NPI Number	:	1457957409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA KATRI CHARLESTON

Provider Business Mailing Address
First Line	:	5401 KINGSWAY CT W
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-5109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 KINGSWAY CT W
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-5109
Country	:	US
Telephone Number	:	513-418-7703
Fax Number	:

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

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	12/07/2020

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Directions to “ ANGELA KATRI CHARLESTON ” Practice Location

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