Provider Demographics
NPI:1184917767
Name:CHARTERS GAVANA, JENEEN KATHRYN (CNA)
Entity type:Individual
Prefix:MRS
First Name:JENEEN
Middle Name:KATHRYN
Last Name:CHARTERS GAVANA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MISS
Other - First Name:JENEEN
Other - Middle Name:KATHRYN
Other - Last Name:CHARTERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:324 SOPHIA COXE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DRIFTON
Mailing Address - State:PA
Mailing Address - Zip Code:18221-0283
Mailing Address - Country:US
Mailing Address - Phone:570-926-5698
Mailing Address - Fax:
Practice Address - Street 1:324 SOPHIA COXE DR
Practice Address - Street 2:
Practice Address - City:DRIFTON
Practice Address - State:PA
Practice Address - Zip Code:18221
Practice Address - Country:US
Practice Address - Phone:570-926-5698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA99563483747P1801X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide