Individual
REN CHILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
4700 HARRISON BLVD, OGDEN, UT 84403-4303
(801) 475-3300
(801) 475-3301
Mailing address
9900 BREN ROAD EAST, MAIL ROUTE MN 008-B213, MINNETONKA, MN 55343
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
7805009-4405
UT
363LF0000X
Family Nurse Practitioner
7805009-4405
UT
Other
Enumeration date
05/18/2016
Last updated
06/23/2020
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