MEDICARE: CHARLENE DEANNA DENGLER DNP, FNP-BC

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	363LF0000X	Family Nurse Practitioner	4704241068	MI

General Provider Information

NPI Number	:	1700623238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE DEANNA DENGLER DNP, FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 203
Second Line	:
City	:	SHEPHERD
State	:	MI
Zip	:	48883-0203
Country	:	US
Telephone Number	:	989-944-3485
Fax Number	:

Provider Business Practice Location Address
First Line	:	1549 WASHINGTON ST
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48640-5685
Country	:	US
Telephone Number	:	989-259-1000
Fax Number	:	989-402-0097

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

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	07/11/2024

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