MEDICARE: CHARLENE WALDRON

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	757377-1	NY

General Provider Information

NPI Number	:	1497394340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE WALDRON

Provider Business Mailing Address
First Line	:	1344 E 104TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4508
Country	:	US
Telephone Number	:	347-575-0178
Fax Number	:

Provider Business Practice Location Address
First Line	:	1344 E 104TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4508
Country	:	US
Telephone Number	:	347-575-0178
Fax Number	:

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

Provider Enumeration Date	:	12/24/2019
Last Update Date	:	12/24/2019

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Directions to “ CHARLENE WALDRON ” Practice Location

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