Individual
MS. CHARLENE OLIVIA JUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
800 HOWARD AVE FL 1, NEW HAVEN, CT 06519-1369
(203) 785-7411
(203) 785-4194
Mailing address
800 HOWARD AVE, NEW HAVEN, CT 06519-1369
(650) 759-1426
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-06058
NC
363A00000X
Physician Assistant
51298
CA
363AM0700X
Medical Physician Assistant
Primary
3263
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
09/23/2007
Last updated
08/04/2019
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