Healthcare Provider Details

I. General information

NPI: 1982136768
Provider Name (Legal Business Name): MICHELLE HAFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W CENTER ST STE 201
LOGAN UT
84321-5804
US

IV. Provider business mailing address

2240 N HWY 89 STE C
HARRISVILLE UT
84404-2675
US

V. Phone/Fax

Practice location:
  • Phone: 801-393-3632
  • Fax: 801-393-4081
Mailing address:
  • Phone: 801-393-3632
  • Fax: 801-393-4081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: