MEDICARE: MR. CHARLES UNDERWOOD RN

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	220129	NC
2	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	535250	NY
3	163WC1500X	Community Health Registered Nurse	220129	NC
4	163WD0400X	Diabetes Educator Registered Nurse	535250	NY
5	163WG0600X	Gerontology Registered Nurse	220129	NC
6	163WG0600X	Gerontology Registered Nurse	535250	NY
7	163WH0200X	Home Health Registered Nurse	220129	NC
8	163WH0200X	Home Health Registered Nurse	535250	NY
9	163WM0705X	Medical-Surgical Registered Nurse	220129	NC
10	163WM0705X	Medical-Surgical Registered Nurse	535250	NY
11	163WP0000X	Pain Management Registered Nurse	220129	NC
12	163WP0808X	Psychiatric/Mental Health Registered Nurse	220129	NC
13	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	220129	NC
14	163WW0000X	Wound Care Registered Nurse	220129	NC
15	163WW0000X	Wound Care Registered Nurse	535250	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932335676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES UNDERWOOD RN

Provider Business Mailing Address
First Line	:	252 MILPASS DR
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-9651
Country	:	US
Telephone Number	:	919-552-4837
Fax Number	:	919-552-4837

Provider Business Practice Location Address
First Line	:	252 MILPASS DR
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-9651
Country	:	US
Telephone Number	:	919-552-4837
Fax Number	:	919-552-4837

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

Provider Enumeration Date	:	06/09/2009
Last Update Date	:	06/09/2009

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