Basic Information
| Provider Information | |||||||||
| NPI: | 1124428636 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDBERG | ||||||||
| FirstName: | CHARLIEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1270 KINGS HWY | ||||||||
| Address2: | |||||||||
| City: | LEWES | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199581735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026844950 | ||||||||
| FaxNumber: | 3026848931 | ||||||||
| Practice Location | |||||||||
| Address1: | 1270 KINGS HWY | ||||||||
| Address2: | |||||||||
| City: | LEWES | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199581735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026844950 | ||||||||
| FaxNumber: | 3026848931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2014 | ||||||||
| LastUpdateDate: | 09/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WS0200X | L1-0040214 | DE | Y | Nursing Service Providers | Registered Nurse | School |
No ID Information.