Provider Demographics
NPI:1376959023
Name:CHARLEEN ANGELL APRN, PLLC
Entity Type:Organization
Organization Name:CHARLEEN ANGELL APRN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:801-867-3263
Mailing Address - Street 1:145 S 400 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2104
Mailing Address - Country:US
Mailing Address - Phone:801-839-4023
Mailing Address - Fax:
Practice Address - Street 1:145 S 400 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2104
Practice Address - Country:US
Practice Address - Phone:801-839-4023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT208123-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty