Provider Demographics
NPI:1902200017
Name:NEAL, CHARLOTTE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 STATE ST
Mailing Address - Street 2:STE 340
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6807
Mailing Address - Country:US
Mailing Address - Phone:502-609-0386
Mailing Address - Fax:
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:STE 340
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6807
Practice Address - Country:US
Practice Address - Phone:812-945-5233
Practice Address - Fax:812-945-2804
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006819A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300000199AMedicaid