MIMI CHARTER (NPI# 1477175446) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477175446 |
| Entity Type | Individual |
| Full Name | MIMI CHARTER |
| Practice Address |
614 S Skyline Dr Carbondale IL 62901-2214 |
| Practice Telephone | 5416479166 |
| Mailing Telephone | 5416479166 |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2020-05-13 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
614 S SKYLINE DR |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901-2214 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831703461 | Madeleine Jake Nieslanik | Student in an Organized Health Care Education/Training Program | 757 County Road 101, Carbondale, CO 81623-2183 | 2020-09-01 |
| 1144843459 | Katherine E. Hersberger | Student in an Organized Health Care Education/Training Program | 710 S Illinois Ave Apt 217, Carbondale, IL 62901-2959 | 2020-05-20 |
| 1528680162 | Mitchell Wayne Sanders | Student in an Organized Health Care Education/Training Program | 2350 S Illinois Ave Apt 8b, Carbondale, IL 62903-5977 | 2020-05-16 |
| 1518493782 | Peter Filip Jr. | Student in an Organized Health Care Education/Training Program | 199 Bittersweet Ln, Carbondale, IL 62903-7829 | 2017-05-10 |
| 1649712829 | Carolyn Fasnacht | Student in an Organized Health Care Education/Training Program | 2775 Skyhawk Rd, Carbondale, IL 62902-1008 | 2016-11-05 |
| 1093186637 | Mackenzie Baird | Student in an Organized Health Care Education/Training Program | 1263 Lincoln Dr, Carbondale, IL 62901-4304 | 2015-10-08 |
| 1063767671 | Ryan C Speelman | Student in an Organized Health Care Education/Training Program | 708 W Mill St Apt 301, Carbondale, IL 62901-2693 | 2012-07-19 |
| 1679749576 | Gina M. Hill | Student in an Organized Health Care Education/Training Program | 4269 Lager Ln, Carbondale, IL 62902-0970 | 2008-05-01 |
| 1104443258 | Kilmeny Clark | Student in an Organized Health Care Education/Training Program | 300 W Oak St, Carbondale, IL 62901-1400 | 2020-07-05 |
| 1548884398 | Amanda Durham | Student in an Organized Health Care Education/Training Program | 300 W Oak St, Carbondale, IL 62901-1400 | 2020-06-07 |
| Find all providers in CARBONDALE | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
Please comment or provide details below to improve the information on MIMI CHARTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.