Provider Demographics
NPI:1871397190
Name:CHARLES, LYNETTA TIAONA (SOLE PROPRIETOR)
Entity type:Individual
Prefix:MRS
First Name:LYNETTA
Middle Name:TIAONA
Last Name:CHARLES
Suffix:
Gender:
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N BERKELEY BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8238
Mailing Address - Country:US
Mailing Address - Phone:919-988-2030
Mailing Address - Fax:
Practice Address - Street 1:2101 N BERKELEY BLVD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-8238
Practice Address - Country:US
Practice Address - Phone:919-988-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
NC172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No374U00000XNursing Service Related ProvidersHome Health Aide