Basic Information
| Provider Information | |||||||||
| NPI: | 1740809797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHARMELO | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | DONALD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1842 BALTIMORE DR | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE VILLAGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600072736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472080695 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5645 W ADDISON ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606342881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732827000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2020 | ||||||||
| LastUpdateDate: | 04/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | 041-240278 | IL | Y | Nursing Service Providers | Registered Nurse | Emergency |
No ID Information.