Individual
CHARLENE B DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1718 E 4TH ST, SUITE 201, CHARLOTTE, NC 28204-3261
(704) 384-0560
(704) 384-0561
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-0560
(704) 384-0561
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
800048
NC
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
800048
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7005695
—
NC
Enumeration date
12/06/2006
Last updated
07/08/2013
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