Healthcare Provider Details

I. General information

NPI: 1851791164
Provider Name (Legal Business Name): CHARISE HULSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 26TH ST
OGDEN UT
84401-3105
US

IV. Provider business mailing address

237 26TH ST
OGDEN UT
84401-3105
US

V. Phone/Fax

Practice location:
  • Phone: 801-625-3700
  • Fax:
Mailing address:
  • Phone: 801-625-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: