Basic Information
Provider Information | |||||||||
NPI: | 1982633020 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALTENBERGER | ||||||||
FirstName: | CHARLES | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ALTENBERGER | ||||||||
OtherFirstName: | CHUCK | ||||||||
OtherMiddleName: | A | ||||||||
OtherNamePrefix: | MR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CRNA | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 10 COMMERCE DR | ||||||||
Address2: |   | ||||||||
City: | NEW ROCHELLE | ||||||||
State: | NY | ||||||||
PostalCode: | 108015214 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9146373510 | ||||||||
FaxNumber: | 9148190061 | ||||||||
Practice Location | |||||||||
Address1: | 1321 COLBY AVE | ||||||||
Address2: |   | ||||||||
City: | EVERETT | ||||||||
State: | WA | ||||||||
PostalCode: | 982011665 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4252612000 | ||||||||
FaxNumber: | 4252614462 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/01/2006 | ||||||||
LastUpdateDate: | 11/17/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AP30006384 | WA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   | 163W00000X | RN00117378 | WA | N |   | Nursing Service Providers | Registered Nurse |   |
No ID Information.