Basic Information
| Provider Information | |||||||||
| NPI: | 1881276640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRICE-BROADWAY | ||||||||
| FirstName: | CHARNIKKA | ||||||||
| MiddleName: | LASHRAY | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1313 CUTTING BLVD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 948042554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102320874 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1313 CUTTING BLVD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 948042554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102320874 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2021 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 701548 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
ID Information
| ID | Type | State | Issuer | Description | 701548 | 01 | CA | BOARD OF PSYCHIATRIC AND VOCATIONAL NURSING | OTHER |