Basic Information
| Provider Information | |||||||||
| NPI: | 1770860975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEGNAUD | ||||||||
| FirstName: | CHARLIE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 WILLIAMS DR | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030515431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038821501 | ||||||||
| FaxNumber: | 6038829747 | ||||||||
| Practice Location | |||||||||
| Address1: | 168 KINSLEY ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030603634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038821501 | ||||||||
| FaxNumber: | 6038829747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2011 | ||||||||
| LastUpdateDate: | 05/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 06528323 | NH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 28224409A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 201304560 | 05 | IN | MEDICAID | 000000952986 | 01 | IN | ANTHEM PROVIDER NUMBER | OTHER |