Healthcare Provider Details

I. General information

NPI: 1689001216
Provider Name (Legal Business Name): SANDRA M HAZZARD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA M ROBINSON

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 S 400 E STE 100
BOUNTIFUL UT
84010-4801
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-397-6200
  • Fax: 801-397-6201
Mailing address:
  • Phone: 801-397-6200
  • Fax: 801-397-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number6937161-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number6937161-4402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: