Provider Demographics
NPI:1578358453
Name:CHARLESTON, LYNDE (RN)
Entity type:Individual
Prefix:
First Name:LYNDE
Middle Name:
Last Name:CHARLESTON
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12455 ROAD 35 1/2
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8416
Mailing Address - Country:US
Mailing Address - Phone:559-645-3550
Mailing Address - Fax:
Practice Address - Street 1:12455 ROAD 35 1/2
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8416
Practice Address - Country:US
Practice Address - Phone:559-645-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95202623163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool