Individual
DEDRA LEANN CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1004 SUGAR CAMP JACKSON FORK RD, SOUTH WEBSTER, OH 45682-9033
(740) 285-0326
(740) 778-4016
Mailing address
1004 SUGAR CAMP JACKSON FORK RD, P.O. BOX 101, SOUTH WEBSTER, OH 45682-9033
(740) 285-0326
(740) 778-4016
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
120152
OH
Other
Enumeration date
08/22/2012
Last updated
08/22/2012
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