Healthcare Provider Details

I. General information

NPI: 1700015260
Provider Name (Legal Business Name): CHARLES M. HERALD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 E 2100 S
SALT LAKE CITY UT
84115-2237
US

IV. Provider business mailing address

2134 LINCOLN ST APT 19
HOLLYWOOD FL
33020-3991
US

V. Phone/Fax

Practice location:
  • Phone: 801-596-2111
  • Fax:
Mailing address:
  • Phone: 954-274-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberEMT 301744
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9079218-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: