Provider Demographics
NPI:1760458046
Name:PURDY, CHARLOTTE (BSN, RN)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:PURDY
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:SIGRID
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN,RN
Mailing Address - Street 1:6 JOSHUA VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1159
Mailing Address - Country:US
Mailing Address - Phone:860-691-1247
Mailing Address - Fax:
Practice Address - Street 1:2100 2ND STREET
Practice Address - Street 2:RM 5314 , USCG HQ, COMDT (CG-1122)
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593
Practice Address - Country:US
Practice Address - Phone:860-444-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT075496163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care