Provider Demographics
NPI:1376675231
Name:BLOOD, CHARLENE (APRN)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:BLOOD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:HOLBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4401 HARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403
Mailing Address - Country:US
Mailing Address - Phone:801-387-5518
Mailing Address - Fax:801-387-5537
Practice Address - Street 1:4401 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403
Practice Address - Country:US
Practice Address - Phone:801-387-5518
Practice Address - Fax:801-387-5537
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3449438900363LF0000X
UT344943-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily