Provider Demographics
NPI:1437531498
Name:CHARLES, GERDA FREDERIC (RN)
Entity type:Individual
Prefix:MISS
First Name:GERDA
Middle Name:FREDERIC
Last Name:CHARLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SARAH DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6322
Mailing Address - Country:US
Mailing Address - Phone:631-432-8682
Mailing Address - Fax:
Practice Address - Street 1:28 SARAH DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6322
Practice Address - Country:US
Practice Address - Phone:631-432-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY532075-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse