Healthcare Provider Details

I. General information

NPI: 1851585988
Provider Name (Legal Business Name): MARIANNE HAINES DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIANNE HAINES DNP

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 N 1200 E STE 104
LEHI UT
84043-2255
US

IV. Provider business mailing address

PO BOX 281
SPRINGVILLE UT
84663-0281
US

V. Phone/Fax

Practice location:
  • Phone: 801-377-0088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number196568-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number10118
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number196568-4405
License Number StateUT
# 7
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number196568-4405
License Number StateUT
# 8
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number196568-4405
License Number StateUT
# 9
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number196568-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: