Provider Demographics
NPI:1851640767
Name:WARD, CHARLENE LAURA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:LAURA
Last Name:WARD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:LAURA
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:935 HIGHLAND BLVD
Mailing Address - Street 2:STE 2180
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6904
Mailing Address - Country:US
Mailing Address - Phone:406-414-5512
Mailing Address - Fax:
Practice Address - Street 1:935 HIGHLAND BLVD STE 2180
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-414-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-47637364SC1501X
MT100933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health