Basic Information
| Provider Information | |||||||||
| NPI: | 1508588484 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AU | ||||||||
| FirstName: | CHARILE | ||||||||
| MiddleName: | C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19720 CAROLINE HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | MANOR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786532479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122968709 | ||||||||
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| Practice Location | |||||||||
| Address1: | 736 IRVING AVE | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154707646 | ||||||||
| FaxNumber: | 3154707649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2022 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 935201 | TX | Y | Nursing Service Providers | Registered Nurse |
No ID Information.