Individual
MISS CHARLESE JI-ARA PANNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
61 BEAVERDAM ROAD, BELLPORT, NY 11713-2125
(631) 803-8327
Mailing address
61 BEAVERDAM ROAD, BELLPORT, NY 11713-2125
(631) 803-8327
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
310526
NY
Other
Enumeration date
09/14/2012
Last updated
09/14/2012
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