Healthcare Provider Details

I. General information

NPI: 1184184863
Provider Name (Legal Business Name): HAFSA M ABDIKADIR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 E TRAVERSEPOINT DR
DRAPER UT
84020-5679
US

IV. Provider business mailing address

267 E TRAVERSEPOINT DR
DRAPER UT
84020-5679
US

V. Phone/Fax

Practice location:
  • Phone: 801-553-8300
  • Fax: 801-553-8301
Mailing address:
  • Phone: 801-553-8300
  • Fax: 801-553-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7604047-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number7604047-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: