Provider Demographics
NPI:1295321594
Name:ALBIN, CHARLENE DENISE (HEALTHCARE PROVIDER)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:DENISE
Last Name:ALBIN
Suffix:
Gender:F
Credentials:HEALTHCARE PROVIDER
Other - Prefix:MRS
Other - First Name:CHARLENE
Other - Middle Name:DENISE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3007
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3007
Mailing Address - Country:US
Mailing Address - Phone:503-535-1150
Mailing Address - Fax:
Practice Address - Street 1:1312 SW WAHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97208
Practice Address - Country:US
Practice Address - Phone:503-535-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist