Provider Demographics
NPI:1205447695
Name:PYSHER, CHARLINE (RN, BSN)
Entity type:Individual
Prefix:
First Name:CHARLINE
Middle Name:
Last Name:PYSHER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:CHARLINE
Other - Middle Name:
Other - Last Name:ILNICKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:36C LOWER WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36C LOWER WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2749
Practice Address - Country:US
Practice Address - Phone:413-533-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2312605163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse