| NPI | 1770243768 | 
|---|---|
| Former Name | CHARLA LYCAN | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 122881) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 0997201-NP) | 
| 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0997201-NP) | |
| Enumeration Date | 2021-12-18 | 
| Last Update Date | 2025-08-15 |