Healthcare Provider Details

I. General information

NPI: 1427961291
Provider Name (Legal Business Name): HALLEE PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 W 2425 N
HARRISVILLE UT
84414-7366
US

IV. Provider business mailing address

579 W 2425 N
HARRISVILLE UT
84414-7366
US

V. Phone/Fax

Practice location:
  • Phone: 435-730-6644
  • Fax:
Mailing address:
  • Phone: 435-730-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13432050-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: