Individual provider Active NPI

Charvel Stanejko, FNP-C

  • Family Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1376316729
Registry record updated Nov 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5019123 Issued in NC
Practice address
2905 Freedom Dr
Charlotte, NC 28208-3857
Phone
(704) 394-3033
NPI assigned
Nov 6, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5019123 NC Primary

Addresses

Primary practice location

2905 Freedom Dr
Charlotte, NC 28208-3857

Mailing address

2905 Freedom Dr
Charlotte, NC 28208-3857

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5019123NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Graces Community Healthcare Inc CurrentSince Nov 12, 2023 Accepting new patients
Freedom Medical Clinic & Urgent Care PA PastSince Nov 12, 2023 Accepting new patients

Locations

2905 Freedom Dr
Charlotte, NC 28208
Phone (704) 394-3033

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1699228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1376316729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2905 FREEDOM DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282083857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2905 FREEDOM DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282083857",
            "telephone_number": "704-394-3033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANEJKO",
        "first_name": "CHARVEL",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-06",
        "last_updated": "2023-11-06",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5019123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.