1104006683 NPI number — MS. CHARLE' CHANSON FRANCINNE AVERY MSN RN ANP-BC GNP-BC

Table of content: MS. CHARLE' CHANSON FRANCINNE AVERY MSN RN ANP-BC GNP-BC (NPI 1104006683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104006683 NPI number — MS. CHARLE' CHANSON FRANCINNE AVERY MSN RN ANP-BC GNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVERY
Provider First Name:
CHARLE'
Provider Middle Name:
CHANSON FRANCINNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN RN ANP-BC GNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104006683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
918 CEDAR TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR HILL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75104-7908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-291-2473
Provider Business Mailing Address Fax Number:
972-291-2473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
918 CEDAR TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR HILL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75104-7908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-679-6845
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  531436 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LG0600X , with the licence number: 531436 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8N7635 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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