Provider Demographics
NPI:1902050297
Name:GIVANS, CHARMAINE ANGELLA (LPN)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:ANGELLA
Last Name:GIVANS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 ACORN AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-3520
Mailing Address - Country:US
Mailing Address - Phone:631-297-4790
Mailing Address - Fax:631-761-1829
Practice Address - Street 1:175 ACORN AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-3520
Practice Address - Country:US
Practice Address - Phone:631-297-4790
Practice Address - Fax:631-761-1829
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295074164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse