Individual
CHARLOTTE JEAN JERDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
910 ALBANY AVE, OGDENSBURG, NY 13669-3008
(315) 393-9892
Mailing address
PO BOX 6, HERMON, NY 13652-0006
(315) 347-3096
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
277919-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02592809
—
NY
Enumeration date
12/13/2006
Last updated
07/14/2008
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