Healthcare Provider Details

I. General information

NPI: 1730837188
Provider Name (Legal Business Name): HAILEY DAWN CHANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 W 4175 S APT SUITE
HOOPER UT
84315-9639
US

IV. Provider business mailing address

5230 W 4175 S APT SUITE
HOOPER UT
84315-9639
US

V. Phone/Fax

Practice location:
  • Phone: 801-814-0570
  • Fax:
Mailing address:
  • Phone: 801-814-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8852593-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number8852593-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: