Provider Demographics
NPI:1386374833
Name:NORDBLAD, KRISSA LEANNE HENDRICKS (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KRISSA
Middle Name:LEANNE HENDRICKS
Last Name:NORDBLAD
Suffix:
Gender:
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:KRISSA
Other - Middle Name:LEANNE
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:615 S ARAPEEN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1239
Mailing Address - Country:US
Mailing Address - Phone:018-581-7761
Mailing Address - Fax:
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-646-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10855266-3102163W00000X
UT10855266-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse